Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan 24;11(1):10.
doi: 10.1186/1742-6405-11-10.

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

Erica N Johnson, Mollie P Roediger, Michael L Landrum, Nancy F Crum-Cianflone, Amy C Weintrob, Anuradha Ganesan, Jason F Okulicz, Grace E Macalino, Brian K Agan  1 ; Infectious Disease Clinical Research Program HIV Working Group
Affiliations

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

Erica N Johnson et al. AIDS Res Ther. .

Abstract

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.

PubMed Disclaimer

References

    1. Palella FJ Jr, Delaney KM, Moorman AC. et al.Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 1998;11:853–860. doi: 10.1056/NEJM199803263381301. - DOI - PubMed
    1. Palella FJ Jr, Deloria-Knoll M, Chmiel JS. et al.Survival benefit of initiating antiretroviral therapy in HIV-infected persons in different CD4+ cell strata. Ann Intern Med. 2003;11:620–626. doi: 10.7326/0003-4819-138-8-200304150-00007. - DOI - PubMed
    1. Gras L, Kesselring AM, Griffith JT. et al.CD4 cell counts of 800 cells/mm3 or greater after 7 years of highly active antiretroviral therapy are feasible in most patients starting with 350 cells/mm3 or greater. J Acquir Immune Defic Syndr. 2007;11:183–192. doi: 10.1097/QAI.0b013e31804d685b. - DOI - PubMed
    1. Moore RD, Keruly JC. CD4+ cell count 6 years after commencement of highly active antiretroviral therapy in persons with sustained virologic suppression. Clin Infect Dis. 2007;11:441–446. doi: 10.1086/510746. - DOI - PubMed
    1. Emery S, Neuhaus JA, Phillips AN. et al.Major clinical outcomes in antiretroviral therapy in (ART)-naive participants and in those not receiving ART at baseline in the SMART study. J Infect Dis. 2008;11:1133–1144. - PubMed

LinkOut - more resources