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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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: firstname.lastname@example.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: D. Dabitao). 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: R. Murphy and D. Dabitao D). 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.