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Virologic Response Differences Between African Americans and European Americans Initiating Highly Active Antiretroviral Therapy With Equal Access to Care

Weintrob, Amy C MD*†; Grandits, Greg A PhD*‡; Agan, Brian K MD*; Ganesan, Anuradha MD; Landrum, Michael L MD; Crum-Cianflone, Nancy F MD, MPH*‖; Johnson, Erica N MD; Ordóñez, Claudia E MA**; Wortmann, Glenn W MD*†; Marconi, Vincent C MDand the IDCRP HIV Working Group

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 2009 - Volume 52 - Issue 5 - p 574-580
doi: 10.1097/QAI.0b013e3181b98537
Clinical Science

Objective: Studies comparing virologic response to highly active antiretroviral therapy (HAART) between African Americans (AA) and European Americans (EA) have been confounded by differences in duration of HIV infection and access to health care. We evaluated virologic response to HAART between ethnicities in a large cohort with fewer confounders.

Methods: The odds of attaining viral suppression at 6- and 12-months post-HAART were determined by multivariate logistic regression for HIV-infected AA and EA prospectively followed in a large US military cohort. Time-to-event methods were used to compare maintenance of suppression.

Results: A total of 1363 subjects (51% AA, 92% men) with viral load results available 6 months after HAART initiation were included. There was no difference between ethnicities in time from seroconversion to HIV diagnosis or HAART initiation or in HAART regimens. Adjusted for multiple demographic and HIV-related factors, AA had significantly lower odds of obtaining undetectable viral loads after 6 (odds ratio 0.6, 95% confidence interval 0.4-0.8, P < 0.001) and 12 months (odds ratio 0.6, 95% confidence interval 0.4-0.8, P = 0.002) of HAART. Once undetectable, there was no difference in time to virologic failure between AA and EA.

Conclusions: Despite similar durations of HIV infection and equal access to health care, AAs were significantly less likely to achieve viral suppression compared with EA.

From the *Infectious Disease Clinical Research Program of the Uniformed Services University of the Health Sciences, Bethesda, MD; †Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC; ‡Division of Biostatistics, University of Minnesota, Division of Biostatistics, Minneapolis, MN; §Infectious Disease Service, National Naval Medical Center, Bethesda, MD; ¶Infectious Disease Service, San Antonio Military Medical Center, San Antonio, TX; ∥Infectious Disease Service, Naval Medical Center San Diego, San Diego, CA; and **Unaffiliated, San Antonio, TX.

Received for publication February 29, 2009; accepted June 1, 2009.

Supported by Infectious Disease Clinical Research Program of the Uniformed Services University of the Health Sciences. The IDCRP is a Department of Defense tri-service program executed through Uniformed Services University of the Health Sciences and the Henry M. Jackson Foundation for the Advancement of Military Medicine, in collaboration with HHS/NIH/NIAID/DCR through Interagency Agreement HU0001-05-2-0011. The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official, or as reflecting the views of the Departments of the Army, Navy, Air Force, or the Department of Defense. The authors have no commercial or other association that might pose a conflict of interest.

Presented in part at the 15th Conference on Retroviruses and Opportunistic Infections, February 3-6, 2008, Boston, MA.

Correspondence to: Amy Weintrob, MD, Infectious Disease Service, Walter Reed Army Medical Center, 6900 Georgia Ave NW, Bldg 2, Ward 63, Room 6312, Washington, DC 20307 (e-mail: Amy.Weintrob@amedd.army.mil).

© 2009 Lippincott Williams & Wilkins, Inc.