The Association of Race, Sociodemographic, and Behavioral Characteristics With Response to Highly Active Antiretroviral Therapy in Women

Anastos, Kathryn MD*; Schneider, Michael F MS†; Gange, Stephen J PhD†; Minkoff, Howard MD‡; Greenblatt, Ruth M MD§; Feldman, Joseph PhD‡; Levine, Alexandra MD∥; Delapenha, Robert MD¶; Cohen, Mardge MD#; for the Women's Interagency HIV Study Collaborative Group

JAIDS Journal of Acquired Immune Deficiency Syndromes:
Clinical Science
Abstract

Objective: To determine the association of race with clinical and laboratory outcomes after initiation of highly active antiretroviral therapy (HAART) in HIV-1-infected women in the United States.

Study Design: Prospective cohort study.

Participants: A total of 961 HIV-1-infected women participating in the Women's Interagency HIV Study initiating HAART between July 1, 1995 and September 30, 2003.

Results: Over a median of 5.1 years of follow-up, in univariate Cox regression analyses, white women were more likely than African American women to attain a virologic response (relative hazard [RH] = 1.34, P = 0.005), less likely to experience viral rebound (RH = 0.76, P = 0.051), and less likely to die (RH = 0.63, P = 0.040). There were no significant differences, however, among racial groups in outcomes after adjustment for pre-HAART CD4+, HIV-1 RNA, history of AIDS-defining illness, age, antiretroviral therapy use, baseline HIV-1 exposure category, and post-HAART behavioral and clinical variables associated with poorer response (discontinuation of HAART, lower income, smoking, current drug use, and depression). Continuous HAART use and lack of depression differed by race and were the strongest predictors of favorable outcomes.

Conclusion: No significant differences by race were found in virologic, immunologic, or clinical outcomes after adjustment for continued HAART use and depression. These findings suggest that strategies to enhance HAART continuation, including assessing pharmacogenetic influences that may result in greater toxicity and discontinuation rates, and treating depression can improve individual and population-based effects of treatment and potentially mitigate racial disparities in AIDS-related outcomes.

Author Information

From the *Departments of Medicine and Epidemiology and Population Health, Montefiore Medical Center, Bronx, NY; †Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡Department of Obstetrics and Gynecology, Maimonides Medical Center and SUNY Health Sciences Center at Brooklyn, New York, NY; §Departments of Medicine and Epidemiology, University of California at San Francisco, CA; ∥University of Southern California School of Medicine, Los Angeles, CA; ¶Department of Medicine, Howard University College of Medicine, Washington, DC; and #Cook County Hospital, Chicago, IL.

Received for publication October 4, 2004; accepted May 17, 2005.

The WIHS is funded by the National Institute of Allergy and Infectious Diseases, with additional supplemental funding from the National Cancer Institute, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, and the National Institute of Craniofacial and Dental Research (U01-AI-35004, U01-AI-31834, U01-AI-34994, AI-34989, U01-HD-32632, U01-AI-34993, U01-AI-42590, N01-AI-35161, RO1 AI48483).

Reprints: Kathryn Anastos, Women's Interagency HIV Study, 3311 Bainbridge Avenue, Bronx, NY 10467 (e-mail: kanastos@verizon.net).

© 2005 Lippincott Williams & Wilkins, Inc.