Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study

Abstract

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease (PLWH). However, there may be similarities and differences between cohort participants and the general population from which they are drawn. Objective: The objective of this analysis was to compare PLWH who have and have not been enrolled in the DC Cohort and assess whether participants are a representative city-wide sample of PLWH living in DC. Methods: Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort were matched to identify PLWH who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between Cohort and non-Cohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care and viral suppression (VS) were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. Results: There were 12,964 known PLWH living in DC at the end of 2016, of which 40.1% were Cohort participants. Compared to non-participants, participants were less likely to be male (68.0% vs 74.9%, P<.001), but more likely to be black (82.3% vs 69.5%, P<.001), have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). Cohort participants were also more likely to ever be diagnosed with Stage 3 HIV disease (59.6% vs. 47.0%, P<.001), have a CD4 <200 cells/microliter in 2017 (6.2% vs 4.6%, P <.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001 and be virally suppressed in 2017. After adjusting for demographics, Cohort participants were significantly more likely to receive care in 2017 (aOR: 1.8, 95%CI: 1.70-2.0), and to ever be VS (aOR: 1.3, 95%CI: 1.2-1.4). Conclusions: These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the Cohort, ongoing assessment of representativeness will be required.