Association of Race and Ethnicity With Initial Prescription of Antiretroviral Therapy Among People With HIV in the US

Abstract

ImportanceIntegrase strand transfer inhibitor (INSTI)–containing antiretroviral therapy (ART) is currently the guideline-recommended first-line treatment for HIV. Delayed prescription of INSTI-containing ART may amplify differences and inequities in health outcomes.ObjectivesTo estimate racial and ethnic differences in the prescription of INSTI-containing ART among adults newly entering HIV care in the US and to examine variation in these differences over time in relation to changes in treatment guidelines.Design, Setting, and ParticipantsRetrospective observational study of 42 841 adults entering HIV care from October 12, 2007, when the first INSTI was approved by the US Food and Drug Administration, to April 30, 2019, at more than 200 clinical sites contributing to the North American AIDS Cohort Collaboration on Research and Design.ExposuresCombined race and ethnicity as reported in patient medical records.Main Outcomes and MeasuresProbability of initial prescription of ART within 1 month of care entry and probability of being prescribed INSTI-containing ART. Differences among non-Hispanic Black and Hispanic patients compared with non-Hispanic White patients were estimated by calendar year and time period in relation to changes in national guidelines on the timing of treatment initiation and recommended initial treatment regimens.ResultsOf 41 263 patients with information on race and ethnicity, 19 378 (47%) as non-Hispanic Black, 6798 (16%) identified as Hispanic, and 13 539 (33%) as non-Hispanic White; 36 394 patients (85%) were male, and the median age was 42 years (IQR, 30 to 51). From 2007-2015, when guidelines recommended treatment initiation based on CD4+ cell count, the probability of ART initiation within 1 month of care entry was 45% among White patients, 45% among Black patients (difference, 0% [95% CI, −1% to 1%]), and 51% among Hispanic patients (difference, 5% [95% CI, 4% to 7%]). From 2016-2019, when guidelines strongly recommended treating all patients regardless of CD4+ cell count, this probability increased to 66% among White patients, 68% among Black patients (difference, 2% [95% CI, −1% to 5%]), and 71% among Hispanic patients (difference, 5% [95% CI, 1% to 9%]). INSTIs were prescribed to 22% of White patients and only 17% of Black patients (difference, −5% [95% CI, −7% to −4%]) and 17% of Hispanic patients (difference, −5% [95% CI, −7% to −3%]) from 2009-2014, when INSTIs were approved as initial therapy but were not yet guideline recommended. Significant differences persisted for Black patients (difference, −6% [95% CI, −8% to −4%]) but not for Hispanic patients (difference, −1% [95% CI, −4% to 2%]) compared with White patients from 2014-2017, when INSTI-containing ART was a guideline-recommended option for initial therapy; differences by race and ethnicity were not statistically significant from 2017-2019, when INSTI-containing ART was the single recommended initial therapy for most people with HIV.Conclusions and RelevanceAmong adults entering HIV care within a large US research consortium from 2007-2019, the 1-month probability of ART prescription was not significantly different across most races and ethnicities, although Black and Hispanic patients were significantly less likely than White patients to receive INSTI-containing ART in earlier time periods but not after INSTIs became guideline-recommended initial therapy for most people with HIV. Additional research is needed to understand the underlying racial and ethnic differences and whether the differences in prescribing were associated with clinical outcomes.

Country of birth is associated with discrepancies in the prescription of two-drug regimens in successfully treated people with HIV in France

“…prescription of boosted-protease inhibitor-or integrase strand transfer inhibitor-containing ART). Indeed, the distribution of these classes suggested important differences in maintenance ART prescriptions by place of birth, as highlighted in previous studies among treatment-naive PWH [1][2][3].…”

“…Recent studies have reported disparities in antiretroviral therapy (ART) prescribing in the United States [1] and France [2,3] as a first line based on race, ethnicity and/or country of birth. Non-White and foreign-born people with HIV (PWH) were less likely to receive integrase stand transfer inhibitor (INSTI)-containing regimens, or to receive them in the earliest calendar periods, than White and native people with HIV.…”

Trends in Time Spent Viremic Among Persons Newly Diagnosed With HIV in San Francisco

“…Another study also reported Latinos were more likely to start ART early (within 1 month) compared with whites. 24 Although Latinos may be likely to initiate ART early, other studies have noted barriers to retention in care and ART adherence in this population related to health literacy, unmet needs for ancillary services, HIV-related stigma, self-efficacy, and patient–provider trust, hindering viral suppression over time. 25 , 26 …”

Artificial-Intelligence-Based Models Coupled with Correspondence Analysis Visualization on ART—Cases from Gombe State, Nigeria: A Comparative Study

“…Several researchers have used different statistical models to predict its epidemiology, such as HIV/AIDS-related cases and their development, which have resulted in the current achievement of undetectable and non-transmissible outcomes among people living with the virus [ 2 , 3 , 4 ]. Some researchers used logistic regression to predict the influence of the early risk factors of SARS-CoV-2 ART associated with the advancement of the disease, and the findings showed that vaccination and early treatment with antivirals have significantly reduced the risk of disease progression.…”

“…Similarly, the chi-square test and stepwise regression to investigate the longer duration of ART in overcoming barriers to long-term adherence, improving the survival of adolescents and young adults with HIV, and the results supported the global goals for HIV prevention and treatment. Zalla et al [ 3 ] employed binomial distribution to examine the differences in race and ethnicity among people entering HIV care for ART medication, and the results indicated no significant difference in ART medication according to race or ethnicity, but Black and Hispanic patients showed a significant difference compared with White patients receiving ART. Torres et al [ 5 ] used a chi-square analysis and a t test to evaluate the frequency incidence difference between S68G and K65R mutations on the basis of the different types of HIV-1.…”