Race/ethnicity and risk of AIDS and death among HIV-infected patients with access to care.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
Retrospective cohort study.


METHODS
4,686 HIV-infected patients (66% White, 20% Black, and 14% Hispanic) initiating ART and who were enrolled in an integrated healthcare system.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Silverberg
Michael J
MJ
Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA. Michael.J.Silverberg@kp.org
Leyden
Wendy
W
Quesenberry
Charles P
CP
Horberg
Michael A
MA
D000163:Acquired Immunodeficiency Syndrome / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D006297:Health Services Accessibility / Q000639:trends; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D044469:Racial Groups / Q000208:ethnology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents