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. 2012 Nov;55(9):1242-51.
doi: 10.1093/cid/cis654. Epub 2012 Sep 26.

Improvement in the health of HIV-infected persons in care: reducing disparities

Richard D Moore  1 , Jeanne C Keruly, John G Bartlett
Affiliations

Improvement in the health of HIV-infected persons in care: reducing disparities

Richard D Moore et al. Clin Infect Dis. 2012 Nov.

Abstract

Background: Despite advances in human immunodeficiency virus (HIV) treatment, major challenges remain in achieving access, retention, and adherence. Our inner-city HIV clinical practice in Baltimore has a diverse patient population with high rates of poverty, black race, and injection drug use (IDU), providing us the opportunity to compare health process and outcomes.

Methods: Using data collected in a clinical HIV cohort in Baltimore, we compared receipt of combination antiretroviral therapy (ART), HIV type 1 (HIV-1) RNA, CD4, incidence of opportunistic illness, and mortality from 1995 to 2010. Comparisons were made of these outcomes by HIV risk group, sex, and race (black, white).

Results: From 1995 to 2010, we followed 6366 patients comprising 27 941 person-years (PY) of follow-up. By 2010, 87% of patients were receiving ART; median HIV-1 RNA was <200 copies/mL, median CD4 was 475 cells/mm(3), opportunistic illness rates were 2.4 per 100 PY, and mortality rates were 2.1 per 100 PY, with no differences by demographic or HIV risk group. The only differences were that the IDU risk group had a median CD4 that was 79 cells/mm(3) lower and HIV-1 RNA 0.16 log(10 )copies/mL higher compared with other risk groups (P < .01). In 2009 a 28-year-old HIV-infected person was estimated to have 45.4 years of life remaining, which did not differ by demographic or behavioral risk group.

Discussion: Our results emphasize that advances in HIV treatment have had a positive impact on all affected demographic and behavioral risk groups in an HIV clinical setting, with an expected longevity for HIV-infected patients that is now 73 years.

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Figures

Figure 1.
Figure 1.
Percentage of patients on combination antiretroviral therapy over time. Abbreviations: HET, heterosexual; IDU, injection drug user; MSM, men who have sex with men.
Figure 2.
Figure 2.
Human immunodeficiency virus type 1 RNA level in copies/mL over time. Abbreviations: HET, heterosexual; IDU, injection drug user; MSM, men who have sex with men.
Figure 3.
Figure 3.
CD4 T-cell count in cells/mm3 over time. Abbreviations: HET, heterosexual; IDU, injection drug user; MSM, men who have sex with men.
Figure 4.
Figure 4.
Incidence of opportunistic illness in events per 100 person-years over time. Abbreviations: HET, heterosexual; IDU, injection drug user; MSM, men who have sex with men.
Figure 5.
Figure 5.
Mortality rate per 100 person-years over time. Abbreviations: HET, heterosexual; IDU, injection drug user; MSM, men who have sex with men.
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References

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