Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care
- 441 Downloads
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.
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.
Retrospective cohort study.
4,686 HIV-infected patients (66% White, 20% Black, and 14% Hispanic) initiating ART and who were enrolled in an integrated healthcare system.
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.
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.
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 WORDSrace ethnicity AIDS survival
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
- 1.CDC. Racial/ethnic disparities in diagnoses of HIV/AIDS–33 states, 2001–2005. MMWR Morb Mortal Wkly Rep. 2007;56:189–93.Google Scholar
- 2.CDC. HIV/AIDS Surveillance Report, 2005. 2007;17:1–54.Google Scholar
- 3.Heron MP, Smith BL. Deaths: leading causes for 2003. Hyattsville, MD: National vital statistics reports; 2007;15:1–92.Google Scholar
- 14.Gordon NP. How does the adult kaiser permanente membership in Northern California compare with the larger community? Oakland: KP Division of Research; 2009. Available at: http://www-dor.kaiser.org/dor/mhsnet/public/kpnc_community.htm. Accessed June 4, 2009.Google Scholar
- 15.US Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1-Infected adults and adolescents. Available at: http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf. Accessed June 4, 2009.
- 19.Centers for Disease Control and Prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR. 1992;41:1–19.Google Scholar
- 22.Cox DR, Oates D. Analysis of survival data. London and New York: Chapman and Hall; 1984.Google Scholar
- 23.Diggle PJ, Liang KY, Zeger SL. Analysis of longitudinal data. New York, NY: Oxford University Press; 1995.Google Scholar
- 24.Epidemiology of HIV/AIDS–United States, 1981–2005. MMWR Morb Mortal Wkly Rep. Jun 2 2006;55:589–92.Google Scholar
- 35.Schackman BR, Ribaudo HJ, Krambrink A, Hughes V, Kuritzkes DR, Gulick RM. Racial differences in virologic failure associated with adherence and quality of life on efavirenz-containing regimens for initial HIV therapy: results of ACTG A5095. J Acquir Immune Defic Syndr. 2007;46:547–54.PubMedCrossRefGoogle Scholar
- 36.Kumar PN, Rodriguez-French A, Thompson MA, et al. A prospective, 96-week study of the impact of Trizivir, Combivir/nelfinavir, and lamivudine/stavudine/nelfinavir on lipids, metabolic parameters and efficacy in antiretroviral-naive patients: effect of sex and ethnicity. HIV Med. 2006;7:85–98.PubMedCrossRefGoogle Scholar