Race/ethnicity and HAART initiation in a military HIV infected cohort

AIDS Research and Therapy

Erica N Johnson⁴  Mollie P Roediger¹  Michael L Landrum⁴  Nancy F Crum-Cianflone³  Amy C Weintrob²  Anuradha Ganesan²  Jason F Okulicz⁴  Grace E Macalino⁵  Brian K Agan⁵ 

[1] Biostatistics Division, University of Minnesota, Minnesota, MN, USA

[2] Infectious Disease Clinic, Walter Reed National Military Medical Center, Bethesda, MD, USA

[3] Naval Health Research Center, San Diego, CA, USA

[4] Infectious Disease Service, San Antonio Military Medical Center, San Antonio, TX, USA

[5] Department of Preventive Medicine and Biometrics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

关键词: African Americans;    Disparities in care;    Indications for HIV treatment;    Ethnicity;    Race;    HAART;    HIV;   

Others  :  789541
DOI  :  10.1186/1742-6405-11-10

 received in 2013-08-24, accepted in 2014-01-15,  发布年份 2014

【 摘 要 】

Background

Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity.

Methods

Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 <200, AIDS event or severe symptoms; Group A), an indication to consider HAART (including CD4 <350; Group B) or electively started HAART (CD4 >350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count <200 cells/mm³. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR).

Results

1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94% male, 46% African American, 40% Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk.

Conclusions

No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.

【 授权许可】

   
2014 Johnson et al.; licensee BioMed Central Ltd.

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