Journal of General Internal Medicine

, Volume 24, Issue 9, pp 1065–1072 | Cite as

Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care

  • Michael J. Silverberg
  • Wendy Leyden
  • Charles P. QuesenberryJr.
  • Michael A. Horberg
Populations at Risk

ABSTRACT

BACKGROUND

Prior studies evaluating racial/ethnic differences in responses to antiretroviral therapy (ART) among HIV-infected patients have not adequately accounted for many potential confounders, and few have included Hispanic patients.

OBJECTIVE

To identify racial/ethnic differences in ART adherence, and risk of AIDS and death after ART initiation for HIV patients with similar access to care.

DESIGN

Retrospective cohort study.

PARTICIPANTS

4,686 HIV-infected patients (66% White, 20% Black, and 14% Hispanic) initiating ART and who were enrolled in an integrated healthcare system.

MEASUREMENTS

Main outcomes evaluated were ART adherence, new AIDS clinical events, and all-cause mortality. The potential confounding effects of demographics, socioeconomic status, ART parameters, HIV disease stage, and other clinical parameters were considered in multivariable models.

RESULTS

Adjusted mean adherence levels were higher among White (70.1%; ref) compared with Black (64.2%; P < 0.001) and Hispanic patients (65.2%; P < 0.001). Adjusted hazard ratios (HR) for the risk of new AIDS events (White patients as reference) were 1.3 (P = 0.09) for Black and 0.9 (P = 0.64) for Hispanic patients. The adjusted HR for AIDS comparing Hispanic to Black patients was 0.7 (P = 0.11). Hispanic patients had fewer deaths compared with other racial/ethnic groups, particularly cancer and cardiovascular-related. However, adjusted HRs for death were 1.2 (P = 0.37) and 0.9 (P = 0.62) for Black and Hispanic patients, respectively, compared with White patients and 0.9 (P = 0.63) for Hispanic compared with Black patients. Adjustment for adherence did not change inferences for AIDS or death.

CONCLUSIONS

In the setting of similar access to care, we did not observe a disparity for the risk of clinical events for racial/ethnic minorities, despite lower ART adherence.

KEY WORDS

race ethnicity AIDS survival 

Notes

ACKNOWLEDGMENTS

This material was presented at the 4th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention, Sydney, Australia, July 22–25, 2007 (#WEPEB107). This research was supported by a Community Benefit grant from Kaiser Permanente Northern California. Dr. Silverberg’s contribution was also supported in part by grant number K01AI071725 from the NIAID. We would like to thank Leo Hurley for assistance with data analysis and helpful discussions during manuscript preparation.

Conflict of Interest

None disclosed.

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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Michael J. Silverberg
    • 1
  • Wendy Leyden
    • 1
  • Charles P. QuesenberryJr.
    • 1
  • Michael A. Horberg
    • 1
  1. 1.Division of ResearchKaiser Permanente Northern CaliforniaOaklandUSA

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