A Comparative Evaluation of Immune Response of Pre- and Post-Antiretroviral Therapy (ART) in Male and Female HIV Patients Attending Some Selected Tertiary Hospitals in Kano State

Background: Sex differences exist in the immunopathology of HIV infection, yet prospective comparative data from sub-Saharan Africa remain limited. Kano State, Nigeria, is a high-burden HIV region where systematic studies on sex-specific immune, endocrine, and biochemical changes before and after ART initiation are lacking. Objective: To compare the immune response profiles of male and female HIV patients before ART initiation (treatment-naïve) and after treatment (follow-up), covering hematological parameters, sex hormones and vitamin D levels, and liver function indices. Methods: This study employed a prospective longitudinal design enrolling 120 newly diagnosed HIV patients (60 males, 60 females). Venous blood samples were collected before ART initiation and at 6 months post-ART. CD4⁺ T cell counts were determined by flow cytometry, complete blood counts by automated haematology analyser, testosterone, oestradiol, follicle-stimulating hormone, luteinising hormone, and 25-hydroxyvitamin D by enzyme-linked immunosorbent assay, and alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase by automated biochemistry analyser. Data were analyzed using SPSS 26.0 Results: Before ART, female patients had significantly higher CD4⁺ T cell counts than males (p=0.032), and a higher prevalence of anaemia (females 73.3% vs males 55.0%, p=0.038). After 6 months of ART, CD4⁺ T cell counts increased significantly in both groups (males: +187 cells/μL, p<0.001; females: +203 cells/μL, p<0.001), but the sex difference disappeared (p=0.412). Regarding sex hormones, testosterone levels improved significantly in males post-ART (from 348±156 ng/dL to 462±178 ng/dL, p=0.002), whereas oestradiol changes in females were not statistically significant (p=0.187). Vitamin D deficiency was highly prevalent before ART (86.7% overall), and post-treatment improvement in 25(OH)D was greater in females than males (+7.2 ng/mL vs +3.8 ng/mL, p=0.041). Among liver function indices, alkaline phosphatase showed an upward trend in both groups (males +18.3 U/L, females +22.7 U/L), with a significantly greater increase in females (p=0.028). Conclusion: Immunohaematological manifestations of HIV infection before ART initiation show significant sex differences, with female patients having higher baseline CD4⁺ T cell counts but a greater anaemia burden. ART effectively reverses most immunohaematological abnormalities, but recovery trajectories for sex hormones and vitamin D are sex-specific, and the greater alkaline phosphatase elevation in females suggests the need to monitor for sex differences in ART-related cholestatic liver injury.