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The Association of Race with Death from AIDS in Continuous HAART Users in the Women's Interagency HIV Study (WIHS): Being Black, death, depression, history of illicit drug use & non-adherence are all associated
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Reported by Jules Levin
CROI 2012 March 5-8 Seattle WA
Kerry Murphy1, Donald Hoover2, Qiuhu Shi3, Mardge Cohen4,5, Monica Gandhi6, Elizabeth Golub7, Deborah R. Gustafson8,9, Celeste Leigh Pearce10, Mary Young11, and Kathryn Anastos1
1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, US, 2Rutgers University, Piscataway, NJ, US, 3School of Health Sciences and Practice/New York Medical College, Valhalla, NY, US, 4Cook County Health and Hospitals System, Chicago, IL, US, 5Rush University, Chicago, IL, US, 6University of California San Francisco, San Francisco, CA, US, 7Johns Hopkins School of Public Health, Baltimore, MD, US, 8State University of New York/Downstate Medical Center, Brooklyn, NY, US, 9University of Gothenburg, Gothenburg, Sweden, 10University of Southern California, Los Angeles, CA, US, and 11Georgetown University, Washington, DC, US
'Being Black, death, depression, history of illicit drug use & non-adherence are all associated'
CROI: Black Women in US Have Doubled Risk of AIDS Death, Regardless of Adherence - written by Mark Mascolini - (03/7/11)
Abstract
Background: Americans of African (Black) compared to European (White) descent have higher rates of HIV infection and AIDS death. Factors influencing these rates may include lower access to care, lower adherence to HAART, genetic or biologic factors. A prior WIHS study found a statistically non-significant lower rate of AIDS death for white compared to black women on continuous HAART [adjusted hazard ratio (aHR) 0.49, p=0.19]. Here we assess the association of race with clinical outcomes in HIV+ women on continuous HAART.
Methods: WIHS is a prospective cohort study initiated in 1993. Included here are 1471 HIV+ WIHS women on continuous HAART. The primary exposure was self-reported race [Black (Hispanic and non-Hispanic), white (Hispanic and non-Hispanic), or other]. We compared ancestry groups by potential confounders and calculated unadjusted competing risk and adjusted proportional hazards models of time to AIDS death, non-AIDS death and new AIDS defining illness (ADI).
Results: In adjusted analyses, Black compared to white women were more likely to experience AIDS death (aHR 2.03, p=0.004) or new ADI (aHR 1.68, p=0.005), but not non- AIDS death (aHR 0.83, p=0.39).
Other significant independent pre-HAART predictors of AIDS death were higher log10 peak viral load (aHR 1.83, p<0.0001), lower nadir CD4 count (aHR 0.65 per 100 cells/ul increment, p<0.0001), depression defined as CESD score ≥16 (aHR 2.13, p<0.0001), HCV viremia (aHR 1.66, p=0.019), HIV acquisition via transfusion (aHR 2.33, p=0.009) and history of illicit drug use (aHR 1.64, p=0.020).
Cumulative incidence of AIDS death at 10 years was 8.2% and 16% for white and black women respectively. Black women and depressed women reported lower HAART adherence (p<0.0001 and p=0.0015 respectively). In additional models with time-updated adherence in 1255 women with data on self-reported adherence, the association of African ancestry with AIDS death remained statistically significant (aHR 2.35, p=0.035). Adherence of ≥95% protected against AIDS death (aHR 0.30, p<0.0001).
Conclusions: In continuous HAART users, black women were more likely than white women to die from AIDS or experience a new ADI after adjusting for confounders. Pharmacogenomic factors impacting ART drug levels differently by race could contribute to this phenomenon. Future studies examining host genetic traits in these women are important and may inform the selection of future HAART regimens for women of African ancestry.
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