TY - JOUR
T1 - Health outcomes among HIV-positive Latinos initiating antiretroviral therapy in North America versus Central and South America
AU - Cesar, Carina
AU - Koethe, John R.
AU - Giganti, Mark J.
AU - Rebeiro, Peter
AU - Althoff, Keri N.
AU - Napravnik, Sonia
AU - Mayor, Angel
AU - Grinsztejn, Beatriz
AU - Wolff, Marcelo
AU - Padgett, Denis
AU - Sierra-Madero, Juan
AU - Gotuzzo, Eduardo
AU - Sterling, Timothy R.
AU - Willig, James
AU - Levison, Julie
AU - Kitahata, Mari
AU - Rodriguez-Barradas, Maria C.
AU - Moore, Richard D.
AU - McGowan, Catherine
AU - Shepherd, Bryan E.
AU - Cahn, Pedro
N1 - Funding Information:
NA-ACCORD: This work was supported by the National Institutes of Health, USA (grants U01-AI069918, U01-AA013566, U24-AA020794, U01-AA020790, U01-AI31834, U01-AI34989, U01-AI34993, U01-AI34994, U01-AI35004, U01-AI35039, U01-AI35040, U01-AI35041, U01-AI35042, U01-AI37613, U01-AI37984, U01-AI38855, U01-AI38858, U01-AI42590, U01-AI68634, U01-AI68636, U01-AI69432, U01-AI69434, U01-DA036935, U01-HD32632, U10-EY08052, U10-EY08057, U10-EY08067, U54-MD007587, UL1-RR024131, UL1-TR000083, UM1-AI35043, G12-MD007583, K01-AI071754, K01-AI093197, K23-EY013707, K24-DA00432, K24-AI065298, KL2-TR000421, MO1-RR-00052, N02-CP55504, P30-AI027763, P30-AI094189, P30-AI27757, P30-AI27767, P30-AI036219, P30-AI50410, P30-AI54999, P30-MH62246, P30 AI110527, R01-AA16893, R01-CA165937, R01-DA04334, R01-DA11602, R01-DA12568, R24-AI067039, R56-AI102622, F31-DA037788, Z01-CP010214, and Z01-CP010176); Disease Control and Prevention, USA (contract CDC200-2006-18797); the Agency for Healthcare Research and Quality, USA (contract 90047713); the Health Resources and Services Administration, USA (contract 90051652); National Institute of Mental Health of the National Institutes of Health (grant K23MH100978); the Canadian Institutes of Health Research, Canada (grants TGF-96118, HCP-97105, CBR-86906, CBR-94036); Canadian Institutes of Health Research New Investigator Award (A. Burchell); Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Additional support was provided by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. CCASAnet: This work was supported by the National Institutes of Health, USA (grant 2-U01-AI069923).
PY - 2016/3/18
Y1 - 2016/3/18
N2 - Introduction: Latinos living with HIV in the Americas share a common ethnic and cultural heritage. In North America, Latinos have a relatively high rate of new HIV infections but lower rates of engagement at all stages of the care continuum, whereas in Latin America antiretroviral therapy (ART) services continue to expand to meet treatment needs. In this analysis, we compare HIV treatment outcomes between Latinos receiving ART in North America versus Latin America. Methods: HIV-positive adults initiating ART at Caribbean, Central and South America Network for HIV (CCASAnet) sites were compared to Latino patients (based on country of origin or ethnic identity) starting treatment at North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) sites in the United States and Canada between 2000 and 2011. Cox proportional hazards models compared mortality, treatment interruption, antiretroviral regimen change, virologic failure and loss to follow-up between cohorts. Results: The study included 8400 CCASAnet and 2786 NA-ACCORD patients initiating ART. CCASAnet patients were younger (median 35 vs. 37 years), more likely to be female (27% vs. 20%) and had lower nadir CD4 count (median 148 vs. 195 cells/μL, p<0.001 for all). In multivariable analyses, CCASAnet patients had a higher risk of mortality after ART initiation (adjusted hazard ratio (AHR) 1.61; 95% confidence interval (CI):1.32 to 1.96), particularly during the first year, but a lower hazard of treatment interruption (AHR: 0.46; 95% CI: 0.42 to 0.50), change to second-line ART (AHR: 0.56; 95% CI: 0.51 to 0.62) and virologic failure (AHR: 0.52; 95% CI: 0.48 to 0.57). Conclusions: HIV-positive Latinos initiating ART in Latin America have greater continuity of treatment but are at higher risk of death than Latinos in North America. Factors underlying these differences, such as HIV testing, linkage and access to care, warrant further investigation.
AB - Introduction: Latinos living with HIV in the Americas share a common ethnic and cultural heritage. In North America, Latinos have a relatively high rate of new HIV infections but lower rates of engagement at all stages of the care continuum, whereas in Latin America antiretroviral therapy (ART) services continue to expand to meet treatment needs. In this analysis, we compare HIV treatment outcomes between Latinos receiving ART in North America versus Latin America. Methods: HIV-positive adults initiating ART at Caribbean, Central and South America Network for HIV (CCASAnet) sites were compared to Latino patients (based on country of origin or ethnic identity) starting treatment at North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) sites in the United States and Canada between 2000 and 2011. Cox proportional hazards models compared mortality, treatment interruption, antiretroviral regimen change, virologic failure and loss to follow-up between cohorts. Results: The study included 8400 CCASAnet and 2786 NA-ACCORD patients initiating ART. CCASAnet patients were younger (median 35 vs. 37 years), more likely to be female (27% vs. 20%) and had lower nadir CD4 count (median 148 vs. 195 cells/μL, p<0.001 for all). In multivariable analyses, CCASAnet patients had a higher risk of mortality after ART initiation (adjusted hazard ratio (AHR) 1.61; 95% confidence interval (CI):1.32 to 1.96), particularly during the first year, but a lower hazard of treatment interruption (AHR: 0.46; 95% CI: 0.42 to 0.50), change to second-line ART (AHR: 0.56; 95% CI: 0.51 to 0.62) and virologic failure (AHR: 0.52; 95% CI: 0.48 to 0.57). Conclusions: HIV-positive Latinos initiating ART in Latin America have greater continuity of treatment but are at higher risk of death than Latinos in North America. Factors underlying these differences, such as HIV testing, linkage and access to care, warrant further investigation.
KW - Antiretroviral therapy
KW - Cohort studies
KW - HIV
KW - Highly active
KW - Latin America
KW - Mortality
KW - North America
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U2 - 10.7448/IAS.19.1.20684
DO - 10.7448/IAS.19.1.20684
M3 - Article
C2 - 26996992
AN - SCOPUS:84963554007
SN - 1758-2652
VL - 19
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 1
M1 - 20684
ER -