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Racial Disparities in Virologic Failure and Tolerability During First-Line HIV Antiretroviral Therapy.

TitleRacial Disparities in Virologic Failure and Tolerability During First-Line HIV Antiretroviral Therapy.
Publication TypeJournal Article
Year of Publication2019
AuthorsBhagwat P, Kapadia SN, Ribaudo HJ, Gulick RM, Currier JS
JournalOpen Forum Infect Dis
Volume6
Issue2
Paginationofz022
Date Published2019 Feb
ISSN2328-8957
Abstract

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.

DOI10.1093/ofid/ofz022
Alternate JournalOpen Forum Infect Dis
PubMed ID30793009
PubMed Central IDPMC6372057
Grant ListUL1 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
Division: 
Comparative Effectiveness & Outcomes Research
Category: 
Faculty Publication