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. 2019 Sep;109(9):1266-1272.
doi: 10.2105/AJPH.2019.305180. Epub 2019 Jul 18.

Trends and Disparities in Mortality and Progression to AIDS in the Highly Active Antiretroviral Therapy Era: Tennessee, 1996-2016

Peter F Rebeiro  1 , April C Pettit  1 , Lindsey Sizemore  1 , Samantha A Mathieson  1 , Carolyn Wester  1 , Aaron Kipp  1 , Bryan E Shepherd  1 , Timothy R Sterling  1
Affiliations

Trends and Disparities in Mortality and Progression to AIDS in the Highly Active Antiretroviral Therapy Era: Tennessee, 1996-2016

Peter F Rebeiro et al. Am J Public Health. 2019 Sep.

Abstract

Objectives. To use statewide surveillance data to examine trends and disparities in mortality and progression from HIV to AIDS comprehensively in Tennessee over the past 20 years.Methods. Individuals diagnosed with HIV in Tennessee from 1996 to 2016 were identified through the Tennessee Department of Health Enhanced HIV/AIDS Reporting System. Clinical AIDS and all-cause mortality were the outcomes. Cox regression yielded adjusted hazard ratios (AHRs) for death and competing risk regression yielded adjusted subhazard ratios (SHRs) for AIDS, with death as the competing event.Results. Individuals with a history of heterosexual contact (AHR = 1.20; 95% confidence interval [CI] = 1.12, 1.29) and injection drug use (AHR = 1.27; 95% CI = 1.18, 1.38) had increased hazards of death relative to those with a history of male-to-male sexual contact. Hazards of death were lower among White (AHR = 0.79; 95% CI = 0.73, 0.85) and Hispanic (AHR = 0.50; 95% CI = 0.40, 0.63) individuals than among Black individuals. Those with heterosexual contact (SHR = 1.20; 95% CI = 1.12, 1.29) and injection drug use (SHR = 1.27; 95% CI = 1.18, 1.38) had a greater risk of AIDS than those with male-to-male sexual contact. White individuals (SHR = 0.85; 95% CI = 0.81, 0.90) had a lower risk of AIDS than Black individuals, and female individuals (SHR = 0.84; 95% CI = 0.79, 0.90) had a lower risk than male individuals.Conclusions. The trends, disparities, and outcomes assessed in our study will inform HIV testing and care linkage program design and implementation in Tennessee.

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Figures

FIGURE 1—
FIGURE 1—
Adjusted Relative Survival, Stratified by Race/Ethnicity, From Multivariable Cox Proportional Hazard Regression of Time From HIV Diagnosis Until Death Among Individuals Diagnosed With HIV: Tennessee, 1996–2016
FIGURE 2—
FIGURE 2—
Adjusted Cumulative Incidence Function of AIDS Diagnosis After HIV Diagnosis, in the Presence of Death Before AIDS Diagnosis as a Competing Event, Stratified by Race/Ethnicity From Multivariable Competing Risk Regression Among Individuals Diagnosed With HIV: Tennessee, 1996–2016
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