Association of self-reported race with AIDS death in continuous HAART users in a cohort of HIV-infected women in the United States.

Abstract

OBJECTIVE:

To assess the association of race with clinical outcomes in HIV-positive women on continuous HAART.

DESIGN:

Prospective study that enrolled women from 1994 to 1995 and 2001 to 2002.

SETTING:

Women's Interagency HIV Study, a community-based cohort in five US cities.

PARTICIPANTS:

One thousand, four hundred and seventy-one HIV-positive continuous HAART users.

MAIN OUTCOME MEASURES:

Times to AIDS and non-AIDS death and incident AIDS-defining illness (ADI) after HAART initiation.

RESULTS:

In adjusted analyses, black vs. white women had higher rates of AIDS death [adjusted hazard ratio (aHR) 2.14, 95% confidence interval (CI) 1.30, 3.50; P = 0.003] and incident ADI (aHR 1.58, 95% CI 1.08, 2.32; P = 0.02), but not non-AIDS death (aHR 0.91, 95% CI 0.59, 1.39; P = 0.65). Cumulative AIDS death incidence at 10 years was 17.3 and 8.3% for black and white women, respectively. Other significant independent pre-HAART predictors of AIDS death included peak viral load (aHR 1.70 per log₁₀, 95% CI 1.34, 2.16; P < 0.001), nadir CD4⁺ cell count (aHR 0.65 per 100 cells/μl, 95% CI 0.56, 0.76; P < 0.001), depressive symptoms by Center for Epidemiology Studies Depression score at least 16 (aHR 2.10, 95% CI 1.51, 2.92; P < 0.001), hepatitis C virus infection (aHR 1.57, 95% CI 1.02, 2.40; P = 0.04), and HIV acquisition via transfusion (aHR 2.33, 95% CI 1.21, 4.49; P = 0.01). In models with time-updated HAART adherence, association of race with AIDS death remained statistically significant (aHR 3.09, 95% CI 1.38, 6.93; P = 0.006).

CONCLUSION:

In continuous HAART-using women, black women more rapidly died from AIDS or experienced incident ADI than their white counterparts after adjusting for confounders. Future studies examining behavioral and biologic factors in these women may further the understanding of HAART prognosis.

• Authors: Kerry Murphy, Donald R Hoover, Qiuhu Shi, Mardge Cohen, Monica Gandhi, Elizabeth T Golub, Deborah R Gustafson, Celeste Leigh Pearce, Mary Young, Kathryn Anastos
• Journal: AIDS (London, England) (AIDS) Vol. 27 Issue 15 Pg. 2413-23 (Sep 24 2013) ISSN: 1473-5571 [Electronic] England
• PMID: 24037210 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
• Copyright: © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Topics

• Acquired Immunodeficiency Syndrome (drug therapy, ethnology, mortality)
• Adult
• Antiretroviral Therapy, Highly Active
• Black People (statistics & numerical data)
• Female
• HIV Infections (drug therapy, ethnology)
• Humans
• Prognosis
• Prospective Studies
• Risk Factors
• Survival Rate
• United States (epidemiology)
• White People (statistics & numerical data)