Closing the Gap in Antiretroviral Initiation and Viral Suppression: Time Trends and Racial Disparities

Charles F. Haines, John A. Fleishman, Baligh R. Yehia, Bryan M Lau, Stephen Berry, Allison Lorna Agwu, Richard D Moore, Kelly Gebo

Research output: Contribution to journalArticle

Abstract

Background: In the current antiretroviral (ART) era, the evolution of HIV guidelines and emergence of new ART agents might be expected to impact the times to ART initiation and HIV virologic suppression. We sought to determine if times to AI and virologic suppression decreased and if disparities exist by age, race/ethnicity, and HIV risk. Methods: We performed a retrospective cohort study of data from 12 sites of the HIV Research Network, a consortium of US clinics caring for HIV-infected patients. HIV-infected adults (≥18 year old) newly presenting for care between 2003 and 2013 were included in this study. Times to AI and virologic suppression were defined as time from enrollment to AI and HIV RNA <400 copies per milliliter, respectively. We conducted time-to-event analyses using competing risk regression in the HIV Research Network cohort from 2003 to 2012 in 2-year intervals, with follow-up through 2013. Results: Among 15,272 participants, 76.9% were male, 48.4% black, and 10.9% were injection drug use with median age of 38 years (interquartile range: 29-46 years). The adjusted subdistribution hazards ratios (SHRs) for AI and virologic suppression each increased for years 2007-2008 [SHR 1.23 (1.16-1.30), and SHR 1.25 (1.17-1.34), respectively], 2009-2010 [1.55 (1.46-1.64), and 1.54 (1.43-1.65), respectively], and 2011-2012 [1.94 (1.83-2.07), and 1.73 (1.61-1.86), respectively] compared with 2003-2004. Blacks had a lower probability of AI than whites and Hispanics. Conclusions: Since 2007, times from enrollment to AI and virologic suppression have decreased significantly compared with 2003-2004, but persisting disparities should be addressed.

Original languageEnglish (US)
Pages (from-to)340-347
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume73
Issue number3
DOIs
StatePublished - Nov 1 2016

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HIV
Anti-Retroviral Agents
Hispanic Americans
Research
Cohort Studies
Retrospective Studies
Guidelines
RNA
Injections
Pharmaceutical Preparations

Keywords

  • antiretroviral therapy
  • HIV
  • HIV clinical care
  • HIV suppression
  • public health

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Closing the Gap in Antiretroviral Initiation and Viral Suppression : Time Trends and Racial Disparities. / Haines, Charles F.; Fleishman, John A.; Yehia, Baligh R.; Lau, Bryan M; Berry, Stephen; Agwu, Allison Lorna; Moore, Richard D; Gebo, Kelly.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 73, No. 3, 01.11.2016, p. 340-347.

Research output: Contribution to journalArticle

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abstract = "Background: In the current antiretroviral (ART) era, the evolution of HIV guidelines and emergence of new ART agents might be expected to impact the times to ART initiation and HIV virologic suppression. We sought to determine if times to AI and virologic suppression decreased and if disparities exist by age, race/ethnicity, and HIV risk. Methods: We performed a retrospective cohort study of data from 12 sites of the HIV Research Network, a consortium of US clinics caring for HIV-infected patients. HIV-infected adults (≥18 year old) newly presenting for care between 2003 and 2013 were included in this study. Times to AI and virologic suppression were defined as time from enrollment to AI and HIV RNA <400 copies per milliliter, respectively. We conducted time-to-event analyses using competing risk regression in the HIV Research Network cohort from 2003 to 2012 in 2-year intervals, with follow-up through 2013. Results: Among 15,272 participants, 76.9{\%} were male, 48.4{\%} black, and 10.9{\%} were injection drug use with median age of 38 years (interquartile range: 29-46 years). The adjusted subdistribution hazards ratios (SHRs) for AI and virologic suppression each increased for years 2007-2008 [SHR 1.23 (1.16-1.30), and SHR 1.25 (1.17-1.34), respectively], 2009-2010 [1.55 (1.46-1.64), and 1.54 (1.43-1.65), respectively], and 2011-2012 [1.94 (1.83-2.07), and 1.73 (1.61-1.86), respectively] compared with 2003-2004. Blacks had a lower probability of AI than whites and Hispanics. Conclusions: Since 2007, times from enrollment to AI and virologic suppression have decreased significantly compared with 2003-2004, but persisting disparities should be addressed.",
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AU - Lau, Bryan M

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AU - Agwu, Allison Lorna

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