title: Race and mental health diagnosis are risk factors for highly active antiretroviral therapy failure in a military cohort despite equal access to care.
abstract: BACKGROUND
  Data suggest that African Americans have lower rates of virologic suppression using highly active antiretroviral therapy (HAART), possibly because of socioeconomic status and access to care. In a US Military clinic, where beneficiaries have ready access to no-cost health care, the impact of several variables (including race) on HIV virologic suppression were examined.
  
  
  METHODS
  Retrospective analysis of antiretroviral-naive patients who began HAART between 1997 and 2003. Demographics, viral loads, CD4 cell counts, and mental health diagnoses were analyzed.
  
  
  RESULTS
  The charts of 129 individuals who initiated their first antiretroviral regimen during the period of observation were evaluated. The overall efficacy of reaching viral suppression was 71% at 12 months and 56% at 24 months. HIV suppression was achieved at 12 months by 63% of African Americans and 92% of whites (P = 0.001). Mental health diagnosis was associated with failure at 24 months (38 vs. 61%; P = 0.034). Being white (odds ratio = 3.5, 95% confidence interval [CI]: 1.2 to 10.3; P = 0.022) and lacking a mental health diagnosis (odds ratio = 8.7, 95% CI: 2.4 to 32.1; P = 0.001) were both associated with increased efficacy at 24 months by multivariate analysis.
  
  
  CONCLUSIONS
  African-American race and the presence of a mental health diagnoses were independently associated with antiretroviral failure. Equal access to care yields high efficacy rates with HAART but does not fully equilibrate racial differences in virologic failure.
authors.affiliation: Department of Internal Medicine, Walter Reed Army Medical Center, Washington DC 20307-5001, USA. joshua.hartzell@na.amedd.army.mil
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Hartzell
authors.forename: Katherine
authors.initials: K
authors.lastname: Spooner
authors.forename: Robin
authors.initials: R
authors.lastname: Howard
authors.forename: Scott
authors.initials: S
authors.lastname: Wegner
authors.forename: Glenn
authors.initials: G
authors.lastname: Wortmann
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000276:immunology / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D008297:Male; D008603:Mental Health; D008887:Military Medicine; D008889:Military Personnel / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D019562:Viral Load; D044465:White People / Q000706:statistics & numerical data*