Underlying Factors Associated with Racial Disparities in HIV Outcomes

Open Forum Infectious Diseases, February 2019

Racial/ethnic disparities in HIV outcomes have persisted despite effective antiretroviral therapy. The landmark ACTG A5257 study, examining initial non-NNRTI based regimens for ART, used clinical and socioeconomic data to assess factors associated with virologic failure and adverse events within racial/ethnic groups. Study authors analyzed data from 1762 participants: 757 self-reported as non-Hispanic black (NHB), 615 as non-Hispanic white (NHW), and 390 as Hispanic. The proportion with virologic failure was higher for NHB (22%) and Hispanic (17%) participants compared with NHWs (9%). Factors associated with virologic failure were poor adherence and higher baseline HIV RNA level. Prior clinical AIDS diagnosis was associated with virologic failure among NHBs only, and unstable housing and illicit drug use for NHWs only. Factors associated with adverse events were female sex in all groups and concurrent use of medications for comorbidities in NHB and Hispanic participants only. This important study shows that modifiable risk factors associated with virologic failure and tolerability of ART differ between racial groups, suggesting interventions to prolong the durability of first-line regimens.