title: Closing the Gap in Antiretroviral Initiation and Viral Suppression: Time Trends and Racial Disparities.
abstract: In the current antiretroviral (ART) era, the evolution of HIV guidelines and emergence of new ART agents might be expected to impact the times to ART initiation and HIV virologic suppression. We sought to determine if times to AI and virologic suppression decreased and if disparities exist by age, race/ethnicity, and HIV risk.
  
  
  
  We performed a retrospective cohort study of data from 12 sites of the HIV Research Network, a consortium of US clinics caring for HIV-infected patients. HIV-infected adults (≥18 year old) newly presenting for care between 2003 and 2013 were included in this study. Times to AI and virologic suppression were defined as time from enrollment to AI and HIV RNA <400 copies per milliliter, respectively. We conducted time-to-event analyses using competing risk regression in the HIV Research Network cohort from 2003 to 2012 in 2-year intervals, with follow-up through 2013.
  
  
  
  Among 15,272 participants, 76.9% were male, 48.4% black, and 10.9% were injection drug use with median age of 38 years (interquartile range: 29-46 years). The adjusted subdistribution hazards ratios (SHRs) for AI and virologic suppression each increased for years 2007-2008 [SHR 1.23 (1.16-1.30), and SHR 1.25 (1.17-1.34), respectively], 2009-2010 [1.55 (1.46-1.64), and 1.54 (1.43-1.65), respectively], and 2011-2012 [1.94 (1.83-2.07), and 1.73 (1.61-1.86), respectively] compared with 2003-2004. Blacks had a lower probability of AI than whites and Hispanics.
  
  
  
  Since 2007, times from enrollment to AI and virologic suppression have decreased significantly compared with 2003-2004, but persisting disparities should be addressed.
authors.affiliation: *Department of Medicine, Division of Infectious Disease, The John Hopkins School of Medicine, Baltimore, MD;†Agency for Healthcare Research and Quality (AHRQ);‡University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA;§Department of Epidemiology, The Johns Hopkins University School of Public Health, Baltimore, MD; and‖The Johns Hopkins Department of Pediatrics, Division of Infectious Diseases, Baltimore, MD.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Haines
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.forename: Baligh R
authors.initials: BR
authors.lastname: Yehia
authors.forename: Bryan
authors.initials: B
authors.lastname: Lau
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Berry
authors.forename: Allison L
authors.initials: AL
authors.lastname: Agwu
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D023241:Antiretroviral Therapy, Highly Active; D044383:Black People / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D019562:Viral Load; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American