Ten-year Survival by Race/Ethnicity and Sex Among Treated, HIV-infected Adults in the United States

Abstract

Background: Ensuring equal access to antiretroviral therapy (henceforth therapy) should alleviate disparities in health outcomes among persons infected with human immunodeficiency virus (HIV). However, evidence supporting the persistence of disparities in survival following therapy initiation is mixed.

Methods: Patients initiating therapy in eight academic medical centers in the Centers for AIDS Research Network of Integrated Clinical Systems between 1 January 1998 and 30 December 2011. Patients (n = 10 017) were followed from therapy initiation until death from any cause, administrative censoring at 10 years after therapy initiation or the end of follow-up on 31 December 2011. The 10-year risk of all-cause mortality was calculated from standardized Kaplan-Meier survival curves.

Results: Patients were followed for a median of 4.7 years (interquartile range: 2.2, 8.2). During 51 121 person-years of follow-up, 1224 of the 10 017 patients died. The overall 10-year mortality risk was 20.2% (95% confidence interval [CI], 19.2%, 21.3%). Black men and women experienced standardized 10-year all-cause mortality risks that were 7.2% (95% CI, 4.3%, 10.1%) and 7.9% (95% CI, 3.9%, 12.0%) larger (absolute difference) than white men. White women, Hispanic men, and Hispanic women all had lower 10-year mortality than white men.

Conclusions: These data serve as a call to action to identify modifiable mechanisms leading to these observed mortality disparities among HIV-infected black patients. Effective interventions are needed to ensure that the goal of the National HIV/AIDS Strategy to overcome health disparities becomes a reality.

Keywords: HIV; antiretroviral therapy; cohort studies; health status disparities; survival analysis.

Figure 1.

Cumulative all-cause mortality standardized^a to total study sample by years from therapy initiation, race/ethnicity and sex, 10 017 human immunodeficiency virus-infected adults, 1998–2011. ^aStandardized by baseline covariates: age at therapy initiation, CD4 count and viral load, all modeled with restricted quadratic splines (with 4 knots located at the 5th, 35th, 65th and 95th percentiles), antiretroviral therapy naivety, prior diagnosis of any AIDS-defining condition at therapy initiation, injection drug use, and history of hepatitis C virus infection. Abbreviation: AA, African-American.

Figure 2.

Cumulative all-cause mortality standardized^a to the total study sample by years from therapy initiation and (A) race/ethnicity or (B) sex, 10 017 human immunodeficiency virus-infected adults, 1998–2011. ^aStandardized by baseline covariates: sex (A) or race (B), age at therapy initiation, CD4 count and viral load, all modeled with restricted quadratic splines (with 4 knots located at the 5th, 35th, 65th, and 95th percentiles), antiretroviral therapy naivety, prior diagnosis of any AIDS-defining condition at therapy initiation, injection drug use, and history of hepatitis C virus infection.