Abstract
National studies show that Blacks with HIV have higher mortality rates compared to Whites. This study aimed to identify trends in Black racial disparities among Texas residents living with HIV. Using HIV surveillance data from the Texas Department of State Health Services, a cohort of HIV-diagnosed patients (N = 70,996) were identified and grouped according to year of diagnosis, 1996–1997 (T1), 1998–2006 (T2), 2007–2010 (T3), and 2011–2013 (T4). Survival analysis was used to examine racial differences in death rate (analysis 1) and clinical progression to AIDS (analysis 2) for each subcohort, using Blacks as the reference group. In analysis 1, Whites (hazard ratio, HR = 0.80, 95% confidence interval, CI = 0.74–0.87, p < 0.001; HR = 0.82, 95% CI = 0.78–0.87, p < 0.001; respectively) and Hispanics (HR = 0.72, 95% CI = 0.66–0.79, p < 0.001; HR = 0.77, 95% CI = 0.74–0.81, p < 0.001, respectively) had lower death rates in T1 and T2. This remained significant after adjusting for covariates. In T3, death rate was higher for Hispanics after adjustment (HR = 1.13, 95% CI = 1.00–1.28, p < 0.05). In T4, death rate was higher for Whites (HR = 1.66, 95% CI = 1.30–2.13, p < 0.001) and Hispanics (HR = 1.66, 95% CI = 1.34–2.06, p < 0.001). These relationships became non-significant after adjusting for covariates. In analysis 2, the rate of clinical progression to AIDS was higher for Hispanics in all subcohorts. The significance remained after adjusting for covariates. The rate of clinical progression to AIDS was lower for Whites after adjustments in T2 and T3. Additional studies are needed to understand factors that may explain this unexpected finding of improved survival for Blacks over time. Such studies may inform decision-making in HIV care to reduce Black HIV disparities.
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References
Hymes KB, Cheung T, Greene JB, Prose NS, Marcus A, Ballard H, et al. Kaposi’s sarcoma in homosexual men-a report of eight cases. Lancet. 1981;2(8247):598–600.
Altman LK. New homosexual disorder worries health officials. The New York Times 1982. http://www.nytimes.com/1982/05/11/science/new-homosexual-disorder-worries-health-officials.html. Accessed 2 Nov 2017.
Altman LK. Rare cancer seen in 41 homosexuals. The New York Times. 1981. http://www.nytimes.com/1981/07/03/us/rare-cancer-seen-in-41-homosexuals.html#. Accessed 2 Nov 2017.
Centers for Disease Control and Prevention. HIV surveillance report, 2015, vol 27. 2016. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf. Accessed 2 Nov 2017.
Centers for Disease Control and Prevention. HIV surveillance report, 2014, vol 26. 2015. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf. Accessed 2 Nov 2017.
U.S. Census Bureau. Annual estimates of the resident population by sex, age, race, and Hispanic origin for the United States and states: April 1, 2010 to July 1, 2014. 2015. http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Accessed 21 Oct 2016.
Sullivan PS, Rosenberg ES, Sanchez TH, Kelley CF, Luisi N, Cooper HL, et al. Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Ann Epidemiol. 2015;25(6):445–54. https://doi.org/10.1016/j.annepidem.2015.03.006.
Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006;96(6):1007–19. https://doi.org/10.2105/AJPH.2005.066720.
Oster AM, Wiegand RE, Sionean C, Miles IJ, Thomas PE, Melendez-Morales L, et al. Understanding disparities in HIV infection between black and white MSM in the United States. AIDS. 2011;25(8):1103–12. https://doi.org/10.1097/QAD.0b013e3283471efa.
Lemly DC, Shepherd BE, Hulgan T, Rebeiro P, Stinnette S, Blackwell RB, et al. Race and sex differences in antiretroviral therapy use and mortality among HIV-infected persons in care. J Infect Dis. 2009;199(7):991–8. https://doi.org/10.1086/597124.
Arnold M, Hsu L, Pipkin S, McFarland W, Rutherford GW. Race, place and AIDS: the role of socioeconomic context on racial disparities in treatment and survival in San Francisco. Soc Sci Med. 2009;69(1):121–8. https://doi.org/10.1016/j.socscimed.2009.04.019.
Beer L, Mattson CL, Bradley H, Skarbinski J. Understanding cross-sectional racial, ethnic, and gender disparities in antiretroviral use and viral suppression among HIV patients in the United States. Medicine. 2016;95(13):e3171. https://doi.org/10.1097/MD.0000000000003171.
Lillie-Blanton M, Stone VE, Snow Jones A, Levi J, Golub ET, Cohen MH, et al. Association of race, substance abuse, and health insurance coverage with use of highly active antiretroviral therapy among HIV-infected women, 2005. Am J Public Health. 2010;100(8):1493–9. https://doi.org/10.2105/AJPH.2008.158949.
Gebo KA, Fleishman JA, Conviser R, Reilly ED, Korthuis PT, Moore RD, et al. Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate sample of HIV patients in 2001. J Acquir Immune Defic Syndr. 2005;38(1):96–103. https://doi.org/10.1097/00126334-200501010-00017.
Henry K, Erice A, Tierney C, Balfour HH Jr, Fischl MA, Kmack A, et al. A randomized, controlled, double-blind study comparing the survival benefit of four different reverse transcriptase inhibitor therapies (three-drug, two-drug, and alternating drug) for the treatment of advanced AIDS. AIDS Clinical Trial Group 193A Study Team. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;19(4):339–49.
Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d'Arminio Monforte A, et al. Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet. 2003;362(9377):22–9. https://doi.org/10.1016/S0140-6736(03)13802-0.
McKinney MM, Wieland MK, Bowen GS, Goosby EP, Marconi KM. States’ responses to Title II of the Ryan White CARE Act. Public Health Rep. 1993;108(1):4–11.
Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. 2010. https://obamawhitehouse.archives.gov/sites/default/files/uploads/NHAS.pdf. Accessed 2 Nov 2017.
Stein R, Pierce T, Hollis N, Smith JHIV. Testing and service delivery among black females—61 health department jurisdictions, United States, 2012–2014. MMWR Morb Mortal Wkly Rep. 2016;65(4):83–5. https://doi.org/10.15585/mmwr.mm6504a3.
Dasgupta S, Oster AM, Li J, Hall HI. Disparities in consistent retention in HIV care—11 states and the District of Columbia, 2011–2013. MMWR Morb Mortal Wkly Rep. 2016;65(4):77–82. https://doi.org/10.15585/mmwr.mm6504a2.
Chiu YW, Hsu CE, Wang MQ, Nkhoma ET. Examining geographic and temporal variations of AIDS mortality: evidence of racial disparities. J Natl Med Assoc. 2008;100(7):788–96. https://doi.org/10.1016/S0027-9684(15)31372-9.
Jain S, Schwarcz S, Katz M, Gulati R, McFarland W. Elevated risk of death for African Americans with AIDS, San Francisco, 1996–2002. J Health Care Poor Underserved. 2006;17(3):493–503. https://doi.org/10.1353/hpu.2006.0106.
Trepka MJ, Niyonsenga T, Fennie KP, McKelvey K, Lieb S, Maddox LM. Sex and racial/ethnic differences in premature mortality due to HIV: Florida, 2000–2009. Public Health Rep. 2015;130(5):505–13. https://doi.org/10.1177/003335491513000513.
Allgood KL, Hunt B, Rucker MG. Black: white disparities in HIV mortality in the United States: 1990–2009. J Racial Ethn Health Disparities. 2016;3(1):168–75. https://doi.org/10.1007/s40615-015-0141-8.
Levine RS, Briggs NC, Kilbourne BS, King WD, Fry-Johnson Y, Baltrus PT, et al. Black-white mortality from HIV in the United States before and after introduction of highly active antiretroviral therapy in 1996. Am J Public Health. 2007;97(10):1884–92. https://doi.org/10.2105/AJPH.2005.081489.
Siddiqi AE, Hu X, Hall HI. Mortality among blacks or African Americans with HIV infection—United States, 2008–2012. MMWR Morb Mortal Wkly Rep. 2015;64(4):81–6.
Texas Department of State Health Services. Texas HIV Epidemiological Profile: 2015. 2017. https://www.dshs.texas.gov/hivstd/epiprofile/. Accessed 2 Nov 2017.
Texas Department of State Health Services. 2013 Texas STD and HIV Epidemiologic Profile. 2014. https://www.dshs.texas.gov/hivstd/reports/EpiProfile_2013.pdf. Accessed 2 Nov 2017.
Texas Department of State Health Services. Texas HIV surveillance report: 2013 Annu Rep 2014. https://www.dshs.texas.gov/hivstd/reports/. Accessed 2 Nov 2017.
Centers for Disease Control and Prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. JAMA. 1993;269(6):729–30.
Schneider E, Whitmore S, Glynn KM, Dominguez K, Mitsch A, McKenna MT. Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years—United States, 2008. MMWR Recomm Rep. 2008;57(Rr-10):1–12.
Carpenter CC, Fischl MA, Hammer SM, Hirsch MS, Jacobsen DM, Katzenstein DA, et al. Antiretroviral therapy for HIV infection in 1997: updated recommendations of the International AIDS Society—USA panel. JAMA. 1997;277(24):1962–9. https://doi.org/10.1001/jama.1997.03540480062040.
Hammer SM, Saag MS, Schechter M, Montaner JS, Schooley RT, Jacobsen DM, et al. Treatment for adult HIV infection: 2006 recommendations of the International AIDS Society—USA panel. JAMA. 2006;296(7):827–43. https://doi.org/10.1001/jama.296.7.827.
Thompson MA, Aberg JA, Cahn P, Montaner JS, Rizzardini G, Telenti A, et al. Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society—USA panel. JAMA. 2010;304(3):321–33. https://doi.org/10.1001/jama.2010.1004.
Porter K, Babiker A, Bhaskaran K, Darbyshire J, Pezzotti P, Porter K, et al. Determinants of survival following HIV-1 seroconversion after the introduction of HAART. Lancet. 2003;362(9392):1267–74.
Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med. 2009;360(18):1815–26. https://doi.org/10.1056/NEJMoa0807252.
Holodniy M, Hornberger J, Rapoport D, Robertus K, MaCurdy TE, Lopez J, et al. Relationship between antiretroviral prescribing patterns and treatment guidelines in treatment-naive HIV-1-infected US veterans (1992–2004). J Acquir Immune Defic Syndr. 2007;44(1):20–9. https://doi.org/10.1097/01.qai.0000248354.63748.54.
Lemp GF, Payne SF, Neal D, Temelso T, Rutherford GW. Survival trends for patients with AIDS. JAMA. 1990;263(3):402–6. https://doi.org/10.1001/jama.1990.03440030089027.
Rothenberg R, Woelfel M, Stoneburner R, Milberg J, Parker R, Truman B. Survival with the acquired immunodeficiency syndrome. Experience with 5833 cases in New York City. N Engl J Med. 1987;317(21):1297–302. https://doi.org/10.1056/NEJM198711193172101.
Yerly S, Perneger TV, Hirschel B, Dubuis O, Matter L, Malinverni R, et al. A critical assessment of the prognostic value of HIV-1 RNA levels and CD4+ cell counts in HIV-infected patients. The Swiss HIV Cohort Study. Arch Intern Med. 1998;158(3):247–52. https://doi.org/10.1001/archinte.158.3.247.
Mellors JW, Rinaldo CR Jr, Gupta P, White RM, Todd JA, Kingsley LA. Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science. 1996;272(5265):1167–70. https://doi.org/10.1126/science.272.5265.1167.
Henrard DR, Phillips JF, Muenz LR, Blattner WA, Wiesner D, Eyster ME, et al. Natural history of HIV-1 cell-free viremia. JAMA. 1995;274(7):554–8. https://doi.org/10.1001/jama.1995.03530070052029.
Eyster ME, Gail MH, Ballard JO, Al-Mondhiry H, Goedert JJ. Natural history of human immunodeficiency virus infections in hemophiliacs: effects of T-cell subsets, platelet counts, and age. Ann Intern Med. 1987;107(1):1–6. https://doi.org/10.7326/0003-4819-107-1-1.
Chang MH, Molla MT, Truman BI, Athar H, Moonesinghe R, Yoon PW. Differences in healthy life expectancy for the US population by sex, race/ethnicity and geographic region: 2008. J Public Health. 2014;37(3):470–9.
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Nduaguba, S.O., Ford, K.H., Wilson, J.P. et al. Trends in Racial/Ethnic Disparities Among Patients Living with HIV in Texas, 1996 to 2013. J. Racial and Ethnic Health Disparities 5, 1023–1032 (2018). https://doi.org/10.1007/s40615-017-0450-1
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DOI: https://doi.org/10.1007/s40615-017-0450-1