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Bhagwat P, Kapadia SN, Ribaudo HJ, et al. Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy. Open Forum Infect Dis. 2019;6(2):ofz022doi: 10.1093/ofid/ofz022.
Bhagwat, P., Kapadia, S. N., Ribaudo, H. J., Gulick, R. M., & Currier, J. S. (2019). Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy. Open forum infectious diseases, 6(2), ofz022. https://doi.org/10.1093/ofid/ofz022
Bhagwat, Priya, et al. "Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy." Open forum infectious diseases vol. 6,2 (2019): ofz022. doi: https://doi.org/10.1093/ofid/ofz022
Bhagwat P, Kapadia SN, Ribaudo HJ, Gulick RM, Currier JS. Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy. Open Forum Infect Dis. 2019 Feb 12;6(2):ofz022. doi: 10.1093/ofid/ofz022. eCollection 2019 Feb. PMID: 30793009; PMCID: PMC6372057.
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Open Forum Infect Dis. 2019 Feb 12;6(2):ofz022. doi: 10.1093/ofid/ofz022. eCollection 2019 Feb.

Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy.

Open forum infectious diseases

Priya Bhagwat, Shashi N Kapadia, Heather J Ribaudo, Roy M Gulick, Judith S Currier

Affiliations

  1. Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, California.
  2. Department of Medicine, Weill Cornell Medicine, New York, New York.
  3. Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  4. Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.

PMID: 30793009 PMCID: PMC6372057 DOI: 10.1093/ofid/ofz022

Abstract

BACKGROUND: Racial/ethnic disparities in HIV outcomes have persisted despite effective antiretroviral therapy. In a study of initial regimens, we found viral suppression varied by race/ethnicity. In this exploratory analysis, we use clinical and socioeconomic data to assess factors associated with virologic failure and adverse events within racial/ethnic groups.

METHODS: Data were from AIDS Clinical Trial Group A5257, a randomized trial of initial regimens with either atazanavir/ritonavir, darunavir/ritonavir, or raltegravir (each combined with tenofovir DF and emtricitabine). We grouped participants by race/ethnicity and then used Cox-proportional hazards regression to examine the impact of demographic, clinical, and socioeconomic factors on the time to virologic suppression and time to adverse event reporting within each racial/ethnic group.

RESULTS: We 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 for 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.

CONCLUSIONS: Clinical and socioeconomic factors that are associated with virologic failure and tolerability of antiretroviral therapy vary between and within racial and ethnic groups. Further research may shed light into mechanisms leading to disparities and targeted strategies to eliminate those disparities.

Keywords: adverse drug events; HIV; antiretroviral therapy; health care disparities; social determinants of health

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