The association of race, sociodemographic, and behavioral characteristics with response to highly active antiretroviral therapy in women

ArticleinJAIDS Journal of Acquired Immune Deficiency Syndromes 39(5):537-44 · September 2005with7 Reads
Source: PubMed
To determine the association of race with clinical and laboratory outcomes after initiation of highly active antiretroviral therapy (HAART) in HIV-1-infected women in the United States. Prospective cohort study. A total of 961 HIV-1-infected women participating in the Women's Interagency HIV Study initiating HAART between July 1, 1995 and September 30, 2003. Over a median of 5.1 years of follow-up, in univariate Cox regression analyses, white women were more likely than African American women to attain a virologic response (relative hazard [RH]=1.34, P=0.005), less likely to experience viral rebound (RH=0.76, P=0.051), and less likely to die (RH=0.63, P=0.040). There were no significant differences, however, among racial groups in outcomes after adjustment for pre-HAART CD4, HIV-1 RNA, history of AIDS-defining illness, age, antiretroviral therapy use, baseline HIV-1 exposure category, and post-HAART behavioral and clinical variables associated with poorer response (discontinuation of HAART, lower income, smoking, current drug use, and depression). Continuous HAART use and lack of depression differed by race and were the strongest predictors of favorable outcomes. No significant differences by race were found in virologic, immunologic, or clinical outcomes after adjustment for continued HAART use and depression. These findings suggest that strategies to enhance HAART continuation, including assessing pharmacogenetic influences that may result in greater toxicity and discontinuation rates, and treating depression can improve individual and population-based effects of treatment and potentially mitigate racial disparities in AIDS-related outcomes.
    • "Impacts of depression on HIV treatment outcomes are not fully explained via impacts on ART adherence. Even after adjusting for ART adherence, depression has been associated with worsened HIV treatment outcomes, including CD4+ T-lymphocyte count decline (Ickovics et al. 2001), increased probability of AIDS-defining illness (Anastos et al. 2005), and AIDS-related mortality (Ickovics et al. 2001). The role of depression in accelerating disease progression is strengthened by the fact that the treatment of depression has been demonstrated to improve ART adherence and viral suppression (Tsai et al. 2010). "
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    • "Substance use (IDU and alcohol abuse) did not impact viral suppression in this study. The existing literature shows mixed results on the association between substance use and viral suppression with some studies showing increased virological failure and others showing no difference [11, 45, 46]. Additional investigations are needed to determine if the type of drug use (stimulant or depressant) mediate this effect. "
    [Show abstract] [Hide abstract] ABSTRACT: Improving outcomes for people with HIV and mental illness will be critical to meeting the goals of the US National HIV/AIDS Strategy. In a retrospective analysis of the 2008-2010 cycles of the locally representative Philadelphia Medical Monitoring Project, we compared the proportions of HIV-infected adults with and without mental illness: (1) retained in care (≥2 primary HIV visits separated by ≥90 days in a 12-month period); (2) prescribed antiretroviral therapy (ART) at any point in a 12-month period; and (3) virally suppressed (HIV-1 RNA ≤200 copies/mL at the last measure in the 12-month period). Multivariable regression assessed associations between mental illness and the outcomes, adjusting for age, gender, race/ethnicity, insurance, alcohol abuse, injection drug use, CD4 count, and calendar year. Of 730 HIV-infected persons, representative of 9409 persons in care for HIV in Philadelphia, 49.0 % had mental illness. In adjusted analyses, there were no significant differences in retention (91.3 vs. 90.3 %; AOR 1.30, 95 % CI 0.63-2.56) and prescription of ART (83.2 vs. 88.7 %; AOR 0.79, 95 % CI 0.49-1.25) between those with and without mental illness. However, mentally ill patients were less likely to achieve viral suppression than those without mental illness (65.9 vs. 74.4 %; AOR 0.64, 95 % CI 0.46-0.90). These findings argue for the need to optimize ART adherence in this population.
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    • "Studies show that people who are infected with HIV are more likely than the general population to develop depression. Left untreated, depression and higher rates of discontinuation of ART were found to contribute substantially to poorer health status and death, in a group of HIV-positive African American and Latina women (Anastos et al., 2005). One prospective longitudinal cohort study of HIV-positive women showed that 77% had chronic or intermittent depressive symptoms (Ickovics et al., 2001). "
    [Show abstract] [Hide abstract] ABSTRACT: The social context of living in poverty has a direct and indirect impact on a woman's health and well-being. This cross-sectional study investigates the relationship between housing and adherence to treatment, emotional wellness, environmental safety, physical health status, and risk behaviors among HIV-positive women receiving services from an AIDS service organization in the mid-South. Significant differences were found between stably housed and unstably housed women on the dependent outcome variables. Results suggest that housing services for HIV-positive women may be an effective way to increase their health and well-being as well as prevent transmission to others.
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