Racial differences in response to antiretroviral therapy for HIV infection: an AIDS clinical trials group (ACTG) study analysis.

TitleRacial differences in response to antiretroviral therapy for HIV infection: an AIDS clinical trials group (ACTG) study analysis.
Publication TypeJournal Article
Year of Publication2013
AuthorsRibaudo HJ, Smith KY, Robbins GK, Flexner C, Haubrich R, Chen Y, Fischl MA, Schackman BR, Riddler SA, Gulick RM
JournalClin Infect Dis
Volume57
Issue11
Pagination1607-17
Date Published2013 Dec
ISSN1537-6591
KeywordsAdult, African Americans, Anti-Retroviral Agents, Chi-Square Distribution, European Continental Ancestry Group, Female, Follow-Up Studies, HIV Infections, Humans, Male, Medication Adherence, Treatment Failure, United States
Abstract

BACKGROUND: In the United States, black individuals infected with human immunodeficiency virus (HIV) have higher rates of virologic failure on antiretroviral therapy (ART) and of death compared to white individuals. The cause for these disparities is uncertain. We sought to examine differences in virologic outcomes among antiretroviral-naive clinical trial participants starting randomized ART and to investigate factors to explain the differences.

METHODS: Individual-level data from participants initiating ART in 5 AIDS Clinical Trials Group studies were analyzed. Included studies were those conducted during 1998-2006 with a primary outcome of virologic failure. The primary outcome measure was time to virologic failure, regardless of ART changes.

RESULTS: A total of 2495 individuals (1151 black; 1344 white) were included with a median follow-up of 129 weeks. Compared to whites, blacks had an increased hazard of virologic failure (hazard ratio [HR]; 1.7; 95% confidence interval [CI], 1.4-1.9; P < .001), with no evidence of heterogeneity across regimens (P = .97); the association remained after adjustment for measured confounders (HR, 1.4; 95% CI, 1.2-1.6; P < .001). Increased hazard of virologic failure was associated with younger age, higher pretreatment HIV type 1 RNA level, lower pretreatment CD4 cell count, hepatitis C antibody, less education, and recent nonadherence to treatment. Sensitivity analyses with different endpoint definitions demonstrated similar results.

CONCLUSIONS: In this analysis, blacks had a 40% higher virologic failure risk than whites that was not explained by measured confounders. The observation was consistent over a range of regimens, suggesting that the difference may be driven by social factors; however, biological factors cannot be ruled out. Further research should identify the sources of racial disparities and develop strategies to reduce them.

DOI10.1093/cid/cit595
Alternate JournalClin. Infect. Dis.
PubMed ID24046302
PubMed Central IDPMC3814827
Grant ListAI062435 / AI / NIAID NIH HHS / United States
AI064086 / AI / NIAID NIH HHS / United States
AI069432 / AI / NIAID NIH HHS / United States
AI069434 / AI / NIAID NIH HHS / United States
AI069465 / AI / NIAID NIH HHS / United States
AI069474 / AI / NIAID NIH HHS / United States
AI27670 / AI / NIAID NIH HHS / United States
AI36214 / AI / NIAID NIH HHS / United States
AI38855 / AI / NIAID NIH HHS / United States
AI38858 / AI / NIAID NIH HHS / United States
AI51966 / AI / NIAID NIH HHS / United States
AI68634 / AI / NIAID NIH HHS / United States
AI69419 / AI / NIAID NIH HHS / United States
AI69472 / AI / NIAID NIH HHS / United States
K24 AI064086 / AI / NIAID NIH HHS / United States
P30 AI073961 / AI / NIAID NIH HHS / United States
UL1 RR024996 / RR / NCRR NIH HHS / United States
UL1 TR000457 / TR / NCATS NIH HHS / United States
UM1 AI069412 / AI / NIAID NIH HHS / United States
UM1 AI069419 / AI / NIAID NIH HHS / United States
UM1 AI069432 / AI / NIAID NIH HHS / United States
UM1 AI069471 / AI / NIAID NIH HHS / United States
UM1 AI069477 / AI / NIAID NIH HHS / United States
UM1 AI069494 / AI / NIAID NIH HHS / United States
UM1-AI068636 / AI / NIAID NIH HHS / United States