title: Race and sex differences in antiretroviral therapy use and mortality among HIV-infected persons in care.
abstract: BACKGROUND
  There are conflicting data regarding race, sex, and mortality among persons infected with human immunodeficiency virus (HIV). We studied all-cause mortality among persons in care during the highly-active antiretroviral therapy (HAART) era.
  
  
  METHODS
  This retrospective cohort study included patients who made>or=1 clinic visit from January 1998 through December 2005.
  
  
  RESULTS
  Of 2605 patients (with 6657 person-years of follow-up), 38% were black and 24% were female. The percentage of time in care while receiving HAART was lower for blacks than for nonblacks (47% vs. 76%; P<.001) and for females than for males (57% vs. 71%; P=.01). There were 253 deaths (38 per 1000 person-years). After adjustment for characteristics at baseline, death was associated with black race (hazard ratio [HR], 1.33; P .04), female sex (HR, 1.53; P .007), injection drug use (IDU) as a risk factor for HIV infection (HR, 1.61; P .009), older age (HR, 1.45 per 10 years; P<.001), a lower CD4 cell count (HR, 0.59 for 200 vs. 350 cells/mm3; P<.001) and a higher HIV type 1 RNA level (HR, 1.35; P<.001). After adjustment for the length of time that HAART was received, black race (HR, 1.00; P .99) and IDU (HR, 1.37; P .09) were no longer associated with death, but female sex was (HR, 1.62; P=.002).
  
  
  CONCLUSIONS
  Race-associated differences in mortality likely resulted from HAART use. Women had an increased risk of death even after adjustment for HAART use. Addressing racial disparities will require improved HAART utilization. Increased mortality among women requires further study.
authors.affiliation: School of Medicine, Department of Biostatistics, Vanderbilt University, Nashville, TN 37203, USA.
authors.forename: Diana C
authors.initials: DC
authors.lastname: Lemly
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Todd
authors.initials: T
authors.lastname: Hulgan
authors.forename: Peter
authors.initials: P
authors.lastname: Rebeiro
authors.forename: Samuel
authors.initials: S
authors.lastname: Stinnette
authors.forename: Robert B
authors.initials: RB
authors.lastname: Blackwell
authors.forename: Sally
authors.initials: S
authors.lastname: Bebawy
authors.forename: Asghar
authors.initials: A
authors.lastname: Kheshti
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Raffanti
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D044469:Racial Groups; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents