title: Racial differences in response to antiretroviral therapy for HIV infection: an AIDS clinical trials group (ACTG) study analysis.
abstract: BACKGROUND
  In the United States, black individuals infected with human immunodeficiency virus (HIV) have higher rates of virologic failure on antiretroviral therapy (ART) and of death compared to white individuals. The cause for these disparities is uncertain. We sought to examine differences in virologic outcomes among antiretroviral-naive clinical trial participants starting randomized ART and to investigate factors to explain the differences.
  
  
  METHODS
  Individual-level data from participants initiating ART in 5 AIDS Clinical Trials Group studies were analyzed. Included studies were those conducted during 1998-2006 with a primary outcome of virologic failure. The primary outcome measure was time to virologic failure, regardless of ART changes.
  
  
  RESULTS
  A total of 2495 individuals (1151 black; 1344 white) were included with a median follow-up of 129 weeks. Compared to whites, blacks had an increased hazard of virologic failure (hazard ratio [HR]; 1.7; 95% confidence interval [CI], 1.4-1.9; P < .001), with no evidence of heterogeneity across regimens (P = .97); the association remained after adjustment for measured confounders (HR, 1.4; 95% CI, 1.2-1.6; P < .001). Increased hazard of virologic failure was associated with younger age, higher pretreatment HIV type 1 RNA level, lower pretreatment CD4 cell count, hepatitis C antibody, less education, and recent nonadherence to treatment. Sensitivity analyses with different endpoint definitions demonstrated similar results.
  
  
  CONCLUSIONS
  In this analysis, blacks had a 40% higher virologic failure risk than whites that was not explained by measured confounders. The observation was consistent over a range of regimens, suggesting that the difference may be driven by social factors; however, biological factors cannot be ruled out. Further research should identify the sources of racial disparities and develop strategies to reduce them.
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Ribaudo
authors.forename: Kimberly Y
authors.initials: KY
authors.lastname: Smith
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Robbins
authors.forename: Charles
authors.initials: C
authors.lastname: Flexner
authors.forename: Richard
authors.initials: R
authors.lastname: Haubrich
authors.forename: Yun
authors.initials: Y
authors.lastname: Chen
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Fischl
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Riddler
authors.forename: Roy M
authors.initials: RM
authors.lastname: Gulick
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV-1; antiretroviral therapy; racial disparity; virologic failure
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