Race/ethnicity and HAART initiation in a military HIV infected cohort

Erica Johnson, Mollie P. Roediger, Michael L. Landrum, Nancy F. Crum-Cianflone, Amy C. Weintrob, Anuradha Ganesan, Jason F. Okulicz, Grace E. Macalino, Brian K. Agan, M. Kortepeter, C. Decker, S. Fraser, J. Hartzell, R. Ressner, P. Waterman, T. Warkentien, T. Whitman, G. Wortmann, M. Zapor, T. LalaniS. Merritt, M. Bavaro, H. Chun, G. Hsue, A. Johnson, C. Eggleston, R. O'Connell, S. Peel, M. Polis, J. Powers, E. Tramont

Research output: Contribution to journalArticle

Abstract

Background: Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity.Methods: Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count 3. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR).Results: 1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94% male, 46% African American, 40% Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk.Conclusions: No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.

Original languageEnglish (US)
Article number10
JournalAIDS Research and Therapy
Volume11
Issue number1
DOIs
StatePublished - Jan 24 2014
Externally publishedYes

Fingerprint

Highly Active Antiretroviral Therapy
HIV
Pneumocystis Pneumonia
African Americans
CD4 Lymphocyte Count
Delivery of Health Care
Odds Ratio
United States Dept. of Health and Human Services
Natural History
Logistic Models
Guidelines

Keywords

  • African Americans
  • Disparities in care
  • Ethnicity
  • HAART
  • HIV
  • Indications for HIV treatment
  • Race

ASJC Scopus subject areas

  • Virology
  • Molecular Medicine
  • Pharmacology (medical)

Cite this

Johnson, E., Roediger, M. P., Landrum, M. L., Crum-Cianflone, N. F., Weintrob, A. C., Ganesan, A., ... Tramont, E. (2014). Race/ethnicity and HAART initiation in a military HIV infected cohort. AIDS Research and Therapy, 11(1), [10]. https://doi.org/10.1186/1742-6405-11-10

Race/ethnicity and HAART initiation in a military HIV infected cohort. / Johnson, Erica; Roediger, Mollie P.; Landrum, Michael L.; Crum-Cianflone, Nancy F.; Weintrob, Amy C.; Ganesan, Anuradha; Okulicz, Jason F.; Macalino, Grace E.; Agan, Brian K.; Kortepeter, M.; Decker, C.; Fraser, S.; Hartzell, J.; Ressner, R.; Waterman, P.; Warkentien, T.; Whitman, T.; Wortmann, G.; Zapor, M.; Lalani, T.; Merritt, S.; Bavaro, M.; Chun, H.; Hsue, G.; Johnson, A.; Eggleston, C.; O'Connell, R.; Peel, S.; Polis, M.; Powers, J.; Tramont, E.

In: AIDS Research and Therapy, Vol. 11, No. 1, 10, 24.01.2014.

Research output: Contribution to journalArticle

Johnson, E, Roediger, MP, Landrum, ML, Crum-Cianflone, NF, Weintrob, AC, Ganesan, A, Okulicz, JF, Macalino, GE, Agan, BK, Kortepeter, M, Decker, C, Fraser, S, Hartzell, J, Ressner, R, Waterman, P, Warkentien, T, Whitman, T, Wortmann, G, Zapor, M, Lalani, T, Merritt, S, Bavaro, M, Chun, H, Hsue, G, Johnson, A, Eggleston, C, O'Connell, R, Peel, S, Polis, M, Powers, J & Tramont, E 2014, 'Race/ethnicity and HAART initiation in a military HIV infected cohort', AIDS Research and Therapy, vol. 11, no. 1, 10. https://doi.org/10.1186/1742-6405-11-10
Johnson E, Roediger MP, Landrum ML, Crum-Cianflone NF, Weintrob AC, Ganesan A et al. Race/ethnicity and HAART initiation in a military HIV infected cohort. AIDS Research and Therapy. 2014 Jan 24;11(1). 10. https://doi.org/10.1186/1742-6405-11-10
Johnson, Erica ; Roediger, Mollie P. ; Landrum, Michael L. ; Crum-Cianflone, Nancy F. ; Weintrob, Amy C. ; Ganesan, Anuradha ; Okulicz, Jason F. ; Macalino, Grace E. ; Agan, Brian K. ; Kortepeter, M. ; Decker, C. ; Fraser, S. ; Hartzell, J. ; Ressner, R. ; Waterman, P. ; Warkentien, T. ; Whitman, T. ; Wortmann, G. ; Zapor, M. ; Lalani, T. ; Merritt, S. ; Bavaro, M. ; Chun, H. ; Hsue, G. ; Johnson, A. ; Eggleston, C. ; O'Connell, R. ; Peel, S. ; Polis, M. ; Powers, J. ; Tramont, E. / Race/ethnicity and HAART initiation in a military HIV infected cohort. In: AIDS Research and Therapy. 2014 ; Vol. 11, No. 1.
@article{e0089d49b4f6413685811a4ea89e52ef,
title = "Race/ethnicity and HAART initiation in a military HIV infected cohort",
abstract = "Background: Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity.Methods: Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count 3. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR).Results: 1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94{\%} male, 46{\%} African American, 40{\%} Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk.Conclusions: No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.",
keywords = "African Americans, Disparities in care, Ethnicity, HAART, HIV, Indications for HIV treatment, Race",
author = "Erica Johnson and Roediger, {Mollie P.} and Landrum, {Michael L.} and Crum-Cianflone, {Nancy F.} and Weintrob, {Amy C.} and Anuradha Ganesan and Okulicz, {Jason F.} and Macalino, {Grace E.} and Agan, {Brian K.} and M. Kortepeter and C. Decker and S. Fraser and J. Hartzell and R. Ressner and P. Waterman and T. Warkentien and T. Whitman and G. Wortmann and M. Zapor and T. Lalani and S. Merritt and M. Bavaro and H. Chun and G. Hsue and A. Johnson and C. Eggleston and R. O'Connell and S. Peel and M. Polis and J. Powers and E. Tramont",
year = "2014",
month = "1",
day = "24",
doi = "10.1186/1742-6405-11-10",
language = "English (US)",
volume = "11",
journal = "AIDS Research and Therapy",
issn = "1742-6405",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Race/ethnicity and HAART initiation in a military HIV infected cohort

AU - Johnson, Erica

AU - Roediger, Mollie P.

AU - Landrum, Michael L.

AU - Crum-Cianflone, Nancy F.

AU - Weintrob, Amy C.

AU - Ganesan, Anuradha

AU - Okulicz, Jason F.

AU - Macalino, Grace E.

AU - Agan, Brian K.

AU - Kortepeter, M.

AU - Decker, C.

AU - Fraser, S.

AU - Hartzell, J.

AU - Ressner, R.

AU - Waterman, P.

AU - Warkentien, T.

AU - Whitman, T.

AU - Wortmann, G.

AU - Zapor, M.

AU - Lalani, T.

AU - Merritt, S.

AU - Bavaro, M.

AU - Chun, H.

AU - Hsue, G.

AU - Johnson, A.

AU - Eggleston, C.

AU - O'Connell, R.

AU - Peel, S.

AU - Polis, M.

AU - Powers, J.

AU - Tramont, E.

PY - 2014/1/24

Y1 - 2014/1/24

N2 - Background: Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity.Methods: Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count 3. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR).Results: 1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94% male, 46% African American, 40% Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk.Conclusions: No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.

AB - Background: Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity.Methods: Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count 3. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR).Results: 1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94% male, 46% African American, 40% Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk.Conclusions: No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.

KW - African Americans

KW - Disparities in care

KW - Ethnicity

KW - HAART

KW - HIV

KW - Indications for HIV treatment

KW - Race

UR - http://www.scopus.com/inward/record.url?scp=84892722708&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892722708&partnerID=8YFLogxK

U2 - 10.1186/1742-6405-11-10

DO - 10.1186/1742-6405-11-10

M3 - Article

C2 - 24460764

AN - SCOPUS:84892722708

VL - 11

JO - AIDS Research and Therapy

JF - AIDS Research and Therapy

SN - 1742-6405

IS - 1

M1 - 10

ER -