Race and Sex Differences in Antiretroviral Therapy Use and Mortality among HIV‐Infected Persons in Care
Open Access
- 1 April 2009
- journal article
- Published by Oxford University Press (OUP) in The Journal of Infectious Diseases
- Vol. 199 (7), 991-998
- https://doi.org/10.1086/597124
Abstract
BackgroundThere are conflicting data regarding race, sex, and mortality among persons infected with human immunodeficiency virus (HIV). We studied all-cause mortality among persons in care during the highly-active antiretroviral therapy (HAART) era MethodsThis retrospective cohort study included patients who made ⩾1 clinic visit from January 1998 through December 2005 ResultsOf 2605 patients (with 6657 person-years of follow-up), 38% were black and 24% were female. The percentage of time in care while receiving HAART was lower for blacks than for nonblacks (47% vs. 76%; P<.001) and for females than for males (57% vs. 71%; P=.01). There were 253 deaths (38 per 1000 person-years). After adjustment for characteristics at baseline, death was associated with black race (hazard ratio [HR], 1.33; P=.04), female sex (HR, 1.53; P=.007), injection drug use (IDU) as a risk factor for HIV infection (HR, 1.61; P=.009), older age (HR, 1.45 per 10 years; P<.001), a lower CD4 cell count (HR, 0.59 for 200 vs. 350 cells/mm3; P<.001) and a higher HIV type 1 RNA level (HR, 1.35; P<.001). After adjustment for the length of time that HAART was received, black race (HR, 1.00; P=.99) and IDU (HR, 1.37; P=.09) were no longer associated with death, but female sex was (HR, 1.62; P=.002) ConclusionsRace-associated differences in mortality likely resulted from HAART use. Women had an increased risk of death even after adjustment for HAART use. Addressing racial disparities will require improved HAART utilization. Increased mortality among women requires further studyKeywords
This publication has 44 references indexed in Scilit:
- Black–White Mortality From HIV in the United States Before and After Introduction of Highly Active Antiretroviral Therapy in 1996American Journal of Public Health, 2007
- Association of Race and Gender with Use of Antiretroviral Therapy Among HIV-infected Individuals in the Southeastern United StatesSouthern Medical Journal, 2007
- Epidemiology of Human Immunodeficiency Virus in the United StatesClinical Microbiology Reviews, 2007
- Racial/Ethnic and Age Disparities in HIV Prevalence and Disease Progression Among Men Who Have Sex With Men in the United StatesAmerican Journal of Public Health, 2007
- Gender Differences in Survival in an HIV/AIDS Cohort from São Paulo, BrazilAIDS Patient Care and STDs, 2007
- Is there a race-based disparity in the survival of veterans with HIV?Journal of General Internal Medicine, 2006
- Causes of death among human immunodeficiency virus (HIV)-infected adults in the era of potent antiretroviral therapy: emerging role of hepatitis and cancers, persistent role of AIDSInternational Journal of Epidemiology, 2004
- Impact of the HIV epidemic in sub-Saharan Africa on the pattern of HIV in the UKAIDS, 2003
- Changes in Mortality Related to Human Immunodeficiency Virus Infection: Comparative Analysis of Inpatient Deaths in 1995 and in 1999–2000Clinical Infectious Diseases, 2003
- Effect of Race and/or Ethnicity in Use of Antiretrovirals and Prophylaxis for Opportunistic Infection: A Review of the LiteraturePublic Health Reports, 2002