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Sex Differences in Active Pulmonary Tuberculosis Outcomes in Mali, West Africa

Djeneba DabitaoUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Amadou SomboroUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Ibrahim SanogoUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Bassirou DiarraUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Chad J. AchenbachDivision of Infectious Diseases and Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;

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Jane L. HollBiological Sciences Division, University of Chicago, Chicago, Illinois;

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Bocar BayaUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Moumine SanogoUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Mamadou WagueUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Nadie CoulibalyUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Mahamadou KoneUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Hawa Baye DrameUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Mohamed TolofoudieUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Bourahima KoneUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Ayouba DiarraUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Mamadou D. CoulibalyUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Kathryn Saliba-ShawCollaborative Clinical Research Branch, Division of Clinical Research, National Institutes of Allergy and Infectious Diseases, Bethesda, Maryland;

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Yacouba TolobaUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Mahamadou DiakiteUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Seydou DoumbiaUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Sabra L. KleinW. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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William R. BishaiDepartment of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, Maryland

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Souleymane DialloUniversity Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa;

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Robert L. MurphyDivision of Infectious Diseases and Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
Biological Sciences Division, University of Chicago, Chicago, Illinois;

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ABSTRACT.

Men and women often respond differently to infectious diseases and their treatments. Tuberculosis (TB) is a life-threatening communicable disease that affects more men than women globally. Whether male sex is an independent risk factor for unfavorable TB outcomes, however, has not been rigorously investigated in an African context, where individuals are likely exposed to different microbial and environmental factors. We analyzed data collected from a cohort study in Mali by focusing on newly diagnosed active pulmonary TB individuals who were treatment naive. We gathered baseline demographic, clinical, and microbiologic characteristics before treatment initiation and also at three time points during treatment. More males than females were affected with TB, as evidenced by a male-to-female ratio of 2.4:1. In addition, at baseline, males had a significantly higher bacterial count and shorter time to culture positivity as compared with females. Male sex was associated with lower smear negativity rate after 2 months of treatment also known as the intensive phase of treatment, but not at later time points. There was no relationship between patients’ sex and mortality from any cause during treatment. This study suggests that sex-based differences in TB outcomes exist, with sex-specific effects on disease outcomes being more pronounced before treatment initiation and during the intensive phase of treatment rather than at later phases of treatment.

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Author Notes

Address correspondence to Djeneba Dabitao, University Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali, West Africa, BP 1805. E-mail: ddabitao@icermali.org

These authors contributed equally to this work.

Financial support: Research described in this publication was supported by the Fogarty International Center and the Office of the Director of the National Institutes of Health through the Office of Research on Women’s Health, under Career Development Award K43TW011426 (principal investigator: Dabitao D). The research was also supported by the Institute for Global Health at the Feinberg School of Medicine of the Northwestern University, under the Catalyzer Award (principal investigators: Dabitao D and Murphy RL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health and Northwestern University.

Authors’ addresses: Djeneba Dabitao, Amadou Somboro, Ibrahim Sanogo, Bassirou Diarra, Bocar Baya, Moumine Sanogo, Mohamed Tolophoudie, Mamadou Wague, Nadie Coulibaly, Mahamadou Kone, Hawa Baye Drame, Bourahima Kone, Ayouba Diarra, Mamadou D. Coulibaly, Kathryn Saliba-Shaw, Yacouba Toloba, Mahamadou Diakite, Seydou Doumbia, and Souleymane Diallo, University Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa, E-mails: ddabitao@icermali.org, asomboro@icermali.org, isanogo@icermali.org, bdiarra@icermali.org, bbaya@icermali.org, smoumine@icermali.org, mtolofoudie@icermali.org, mwague@icermali.org, nadie@icermali.org, mahakone@icermali.org, hawa.drame@icermali.org, bkone@icermali.org, adiarra@icemrwaf.org, mdcoulibaly@icermali.org, katy.saliba@nih.gov, toloba71@yahoo.fr, mdiakite@icermali.org, sdoumbi@gmail.com, and solo@icermali.org. Chad J. Achenbach, Division of Infectious Diseases and Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, E-mail: c-achenbach@northwestern.edu. Jane L. Holl, Biological Sciences Division, University of Chicago, Chicago, IL, E-mail: jholl@neurology@bsd.uchicago.edu. Sabra L. Klein, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Graduate Program in Immunology, Johns Hopkins School of Medicine, Baltimore, MD, E-mail: sklein2@jhu.edu. William R. Bishai, Department of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, MD, E-mail: wbishai1@jhmi.edu. Robert L. Murphy, Division of Infectious Diseases and Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, and Biological Sciences Division, University of Chicago, Chicago, IL, E-mail: r-murphy@northwestern.edu.

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