Effectiveness of highly-active antiretroviral therapy by race/ethnicity.
OBJECTIVE
To determine the effectiveness of HAART by race/ethnicity.


METHODS
Prospective multicenter cohort study.


METHODS
We studied 991 African-Americans and 911 European-Americans enrolled in the United States Military's Tri-Service AIDS Clinical Consortium Natural History Study who had dates of HIV seroconversion known within 5 years and followed between 1990 and 2002. We determined the rate of disease progression to AIDS and death for subjects in this cohort. Multivariable models evaluated race, pre-HAART (1990-1995) and HAART (1996-2002) eras, age, gender and military service.


RESULTS
In the pre-HAART era, African-Americans had a statistically nonsignificant trend towards better outcomes: the relative hazards (RH) of AIDS and death for African-Americans compared to European-Americans were 0.85 [95% confidence interval (CI), 0.68-1.05] and 0.77 (95% CI, 0.55-1.08), respectively. In the HAART era, outcomes were similar by race: 1.17 (95% CI, 0.86-1.61) for AIDS and 1.11 (95% CI, 0.81-1.53) for death with overlapping Kaplan-Meier curves. Relative to the pre-HAART era, the adjusted RH of AIDS in the HAART era was 0.41 (95% CI, 0.31-0.54) and 0.30 (95% CI, 0.22-0.40) for African-American and European-American participants, respectively. Analogous RH for death were 0.55 (95% CI, 0.38-0.80) and 0.38 (95% CI, 0.27-0.54). The precipitous declines in AIDS and death in the HAART era were not statistically different by race.


CONCLUSIONS
: In a large multi-racial cohort with equal access to health care, HIV treatment outcomes by race/ethnicity were similar.
Silverberg
Michael J
MJ
Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA. Michael.J.Silverberg@kp.org
Wegner
Scott A
SA
Milazzo
Mark J
MJ
McKaig
Rosemary G
RG
Williams
Carolyn F
CF
Agan
Brian K
BK
Armstrong
Adam W
AW
Gange
Stephen J
SJ
Hawkes
Clifton
C
O'Connell
Robert J
RJ
Ahuja
Sunil K
SK
Dolan
Matthew J
MJ
D017088:AIDS-Related Opportunistic Infections / Q000208:ethnology; D000163:Acquired Immunodeficiency Syndrome / Q000208:ethnology; D000328:Adult; D001741:Black or African American; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology*; D006679:HIV Seropositivity / Q000208:ethnology; D015497:HIV-1; D006801:Humans; D008297:Male; D008889:Military Personnel; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People