|Racial Disparities in Virologic Failure and Tolerability During First-Line HIV Antiretroviral Therapy.
|Year of Publication
|Bhagwat P, Kapadia SN, Ribaudo HJ, Gulick RM, Currier JS
|Open Forum Infect Dis
Background: Racial/ethnic disparities in HIV outcomes have persisted despite effective antiretroviral therapy. In a study of initial regimens, we found viral suppression varied by race/ethnicity. In this exploratory analysis, we use clinical and socioeconomic data to assess factors associated with virologic failure and adverse events within racial/ethnic groups.
Methods: Data were from AIDS Clinical Trial Group A5257, a randomized trial of initial regimens with either atazanavir/ritonavir, darunavir/ritonavir, or raltegravir (each combined with tenofovir DF and emtricitabine). We grouped participants by race/ethnicity and then used Cox-proportional hazards regression to examine the impact of demographic, clinical, and socioeconomic factors on the time to virologic suppression and time to adverse event reporting within each racial/ethnic group.
Results: We analyzed data from 1762 participants: 757 self-reported as non-Hispanic black (NHB), 615 as non-Hispanic white (NHW), and 390 as Hispanic. The proportion with virologic failure was higher for NHB (22%) and Hispanic (17%) participants compared with NHWs (9%). Factors associated with virologic failure were poor adherence and higher baseline HIV RNA level. Prior clinical AIDS diagnosis was associated with virologic failure for NHBs only, and unstable housing and illicit drug use for NHWs only. Factors associated with adverse events were female sex in all groups and concurrent use of medications for comorbidities in NHB and Hispanic participants only.
Conclusions: Clinical and socioeconomic factors that are associated with virologic failure and tolerability of antiretroviral therapy vary between and within racial and ethnic groups. Further research may shed light into mechanisms leading to disparities and targeted strategies to eliminate those disparities.
|Open Forum Infect Dis
|PubMed Central ID
|UL1 RR024996 / RR / NCRR NIH HHS / United States
T32 MH073553 / MH / NIMH NIH HHS / United States
UM1 AI068634 / AI / NIAID NIH HHS / United States
UM1 AI069419 / AI / NIAID NIH HHS / United States
T32 MH109205 / MH / NIMH NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States
Racial Disparities in Virologic Failure and Tolerability During First-Line HIV Antiretroviral Therapy.
Submitted by chz4003 on August 12, 2019 - 12:55pm
Comparative Effectiveness & Outcomes Research