title: Disparities in outcomes for African American and Latino subjects in the Flexible Initial Retrovirus Suppressive Therapies (FIRST) trial.
abstract: To benefit maximally from antiretroviral therapy, patients with HIV infection must enter care before their disease is advanced and adhere to care. We sought to determine if and where on this continuum of care racial/ethnic disparities were evident. Data from the Flexible Initial Retrovirus Suppressive Therapies (FIRST) trial, which evaluated three strategies for initial HIV therapy, were compared for White, African American, and Latino subjects. Outcomes included progression of disease and death, HIV viral suppression, and change in CD4(+) cell count. Multivariate Cox proportional hazard models adjusted for known predictors of survival. There were 1357 subjects, including 368 non-Latino white, 751 non-Latino African American, and 238 Latino subjects. At baseline, the two latter groups were more likely to have had AIDS and had lower CD4(+) cell counts than white subjects. In follow-up, African American subjects had lower self-reported adherence to therapy, lower CD4(+) cell count increases, and lower odds of viral suppression. African American and Latino subjects had unadjusted hazard ratios of progression of disease or death of 1.57 (1.17, 2.10; p = 0.0025) and 1.57 (1.09, 2.26; p = 0.02), respectively. Adjusting for baseline differences and differences in adherence, CD4(+) cell count change, and viral suppression accounted for the disparities in outcomes. Opportunities to reduce disparities in outcomes for African American and Latino patients exist along the continuum of HIV care. Efforts to promote access to HIV testing and care and to improve adherence have the potential to reduce racial/ethnic disparities in outcomes of patients with HIV infection.
authors.affiliation: Baylor College of Medicine, Michael E. DeBakey VA Medical Center, and Thomas Street Health Center, Houston, Texas 77030, USA. tpg@bcm.tmc.edu
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
authors.forename: Glenn
authors.initials: G
authors.lastname: Bartsch
authors.forename: Yafeng
authors.initials: Y
authors.lastname: Zhang
authors.forename: Ellen
authors.initials: E
authors.lastname: Tedaldi
authors.forename: Judith
authors.initials: J
authors.lastname: Absalon
authors.forename: Sharon
authors.initials: S
authors.lastname: Mannheimer
authors.forename: Avis
authors.initials: A
authors.lastname: Thomas
authors.forename: Rodger D
authors.initials: RD
authors.lastname: MacArthur
mesh_terms: D001741:Black or African American; D019380:Anti-HIV Agents / Q000627:therapeutic use; D044383:Black People; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology* / Q000401:mortality; D015497:HIV-1 / Q000187:drug effects; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D055118:Medication Adherence; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D015996:Survival Rate; D016896:Treatment Outcome; D044465:White People
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors