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

Murphy, Kerrya; Hoover, Donald R.b; Shi, Qiuhuc; Cohen, Mardged,e; Gandhi, Monicaf; Golub, Elizabeth T.g; Gustafson, Deborah R.h,i; Pearce, Celeste Leighj; Young, Maryk; Anastos, Kathryna

doi: 10.1097/01.aids.0000432537.92958.73
Clinical Science

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.

aAlbert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York

bRutgers University, Piscataway, New Jersey

cSchool of Health Sciences and Practice/New York Medical College, Valhalla, New York

dCook County Health and Hospitals System

eRush University, Chicago, Illinois

fUniversity of California San Francisco, San Francisco, California

gJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

hState University of New York/Downstate Medical Center, Brooklyn, New York, USA

iUniversity of Gothenburg, Gothenburg, Sweden

jUniversity of Southern California, Los Angeles, California

kGeorgetown University, Washington, District of Columbia, USA.

Correspondence to Kerry Murphy, MD, Albert Einstein College of Medicine, Montefiore Medical Center, Department of Medicine, Division of Infectious Diseases, 1300 Morris Park Avenue, Belfer Building, Rm 610, Bronx, NY 10461, USA. Tel: +1 718 515-2593; fax: +1 718 547-0584; e-mail: kerry.murphy@einstein.yu.edu

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.AIDSonline.com).

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.

Received April 4, 2013

Accepted June 27, 2013

© 2013 Lippincott Williams & Wilkins, Inc.