Ethnicity and discordance in plasma HIV-1 RNA viral load and CD4+ lymphocyte count in a cohort of HIV-1-infected individuals

Smith, Penelope; Sarner, Liat; Murphy, Maurice; James, Beki; Thomas, Joyce; Skinner, Charlotte

doi:10.1016/s1386-6532(02)00180-4

Cited by 24 publications

(22 citation statements)

References 16 publications

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“…To put our study results in context, it is particularly useful to evaluate studies among other populations with access to comprehensive medical coverage, including countries with universal health care, 6,9 and the U.S. military, 5,8,11,12 which provides free health insurance to current and retired personnel. Several of these indicated no differences in clinical outcomes comparing Black and White HIV-infected populations, including studies in Denmark, 6 the United Kingdom, 9 and 2 large studies of U.S. military personnel 8 and U.S. veterans. 5 However, another large study of veterans indicated that Black and Hispanic patients each had a 41% higher age-adjusted risk of death over White patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is not firmly established whether equal access for HIV-infected persons would result in similar clinical outcomes among racial/ethnic groups. Others have investigated differences in the risk of AIDS or death by race/ethnicity, [4][5][6][7][8][9][10][11][12] but few have included Hispanic patients. 4,10,11,13 Most studies have reported no racial/ethnic differences in clinical progression of HIV, [4][5][6][7][8][9][10]13 although 1 large study indicated that Black and Hispanic patients had higher mortality rates compared with White patients, 11 and another indicated higher mortality rates for Hepatitis C co-infected White compared with Black patients.…”

Section: Introductionmentioning

confidence: 99%

“…Others have investigated differences in the risk of AIDS or death by race/ethnicity, [4][5][6][7][8][9][10][11][12] but few have included Hispanic patients. 4,10,11,13 Most studies have reported no racial/ethnic differences in clinical progression of HIV, [4][5][6][7][8][9][10]13 although 1 large study indicated that Black and Hispanic patients had higher mortality rates compared with White patients, 11 and another indicated higher mortality rates for Hepatitis C co-infected White compared with Black patients. 12 However, studies were limited by small sample sizes for certain racial/ethnic subgroups, 4,6,9,10,12,13 and limited 7,8,11 or no adjustment 9,12 for potential confounders.…”

Section: Introductionmentioning

confidence: 99%

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Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care

et al. 2009

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BACKGROUND: Prior studies evaluating racial/ethnic differences in responses to antiretroviral therapy (ART) among HIV-infected patients have not adequately accounted for many potential confounders, and few have included Hispanic patients. OBJECTIVE:To identify racial/ethnic differences in ART adherence, and risk of AIDS and death after ART initiation for HIV patients with similar access to care. DESIGN:Retrospective cohort study.PARTICIPANTS: 4,686 HIV-infected patients (66% White, 20% Black, and 14% Hispanic) initiating ART and who were enrolled in an integrated healthcare system. MEASUREMENTS:Main outcomes evaluated were ART adherence, new AIDS clinical events, and all-cause mortality. The potential confounding effects of demographics, socioeconomic status, ART parameters, HIV disease stage, and other clinical parameters were considered in multivariable models. RESULTS:Adjusted mean adherence levels were higher among White (70.1%; ref) compared with Black (64.2%; P<0.001) and Hispanic patients (65.2%; P< 0.001). Adjusted hazard ratios (HR) for the risk of new AIDS events (White patients as reference) were 1.3 (P=0.09) for Black and 0.9 (P=0.64) for Hispanic patients. The adjusted HR for AIDS comparing Hispanic to Black patients was 0.7 (P=0.11). Hispanic patients had fewer deaths compared with other racial/ethnic groups, particularly cancer and cardiovascular-related. However, adjusted HRs for death were 1.2 (P=0.37) and 0.9 (P=0.62) for Black and Hispanic patients, respectively, compared with White patients and 0.9 (P= 0.63) for Hispanic compared with Black patients. Adjustment for adherence did not change inferences for AIDS or death. CONCLUSIONS:In the setting of similar access to care, we did not observe a disparity for the risk of clinical events for racial/ethnic minorities, despite lower ART adherence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care

et al. 2009

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“…This is likely explained by the higher percentage of black females in the immigrant group. HIV-infected females and black patients generally have lower viral loads at given CD4 cell counts (Saul, Erwin, Sabin, Kulasegaram, & Peters, 2001;Smith et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Which method of adherence measurement is most suitable for daily use to predict virological failure among immigrant and non-immigrant HIV-1 infected patients?

et al. 2009

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In industrialized countries, virological failure occurs more often among HIV-infected immigrant patients. Non-adherence is the most credible explanation. We compared adherence of immigrant patients with that of non-immigrant patients in the Netherlands, and investigated which method of adherence measurement is most suitable for daily use to predict virological treatment failure: testing knowledge of the current regimen, a quantitative adherence interview, pharmacy prescription refill ratio (dispensed medication divided by prescribed medication, DM/PM), and plasma drug levels. Included were 61 immigrants and 81 non-immigrants. Virological failure did occur more often in immigrants than in non-immigrants (19.7% (12/61) versus 8.6% (7/81), p=0.056), especially among previously naive patients (19.6% (11/56) versus 0% (0/54), p<0.01). There were no differences between both groups on any of the four adherence measures. Virological failure was associated with reporting stopping medication when not feeling well (OR=12, 95%CI=1.9-77.7, p=0.02), and, among naive patients, also with a DM/PM < 0.85 (Odds Ratio=5.1, 95%Confidence Interval=1.2-22.3, p=0.03). Although our study confirmed a much higher virological failure rate among immigrants, we were unable to identify clear differences in adherence between immigrants and non-immigrant patient, although virological failure was associated with stopping medication when not feeling well and a low DM/PM. Unstructured treatment interruptions are a likely explanation of the findings. Interventions should be aimed at preventing patients to stop medication. A DM/PM below 0.85 can be indicative for patients who did stop medication and are at risk for virological failure.

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“…In general, patients infected with antiretroviral-resistant virus tend to have lower HIV-1 loads than do those infected with wild-type virus [55], and women and African Americans have lower baseline HIV-1 loads when stratified by CD4 + T cell count than do white men, despite similar rates of clinical progression [56,57]. Approximately 7% of patients achieve an undetectable HIV-1 load (defined as !400 copies/mL) after seroconversion; this is more likely to occur in patients with higher CD4 + T cell counts, women, and those who have a lower first HIV-1 load after diagnosis during acute infection [58].…”

Section: Other Factors Affecting Hiv-1 Loadmentioning

confidence: 99%

HIV‐1 Load Quantitation: A 17‐Year Perspective

Holodniy

2006

J INFECT DIS

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Although my introduction to Tom Merigan had been a year earlier, during my Infectious Diseases fellowship interviews at Stanford University, nothing prepared me for the laboratory experience I was about to start in 1988. It was a time during the infancy of HIV-1 clinical trials, when azidothymidine (zidovudine) monotherapy had just been found to decrease HIV-associated morbidity and mortality [1] and was then currently being evaluated in the AIDS Clinical Trials Group protocols 016 and 019. Other than clinical end points such as newly diagnosed AIDS-defining illnesses or death, CD4 + T cell counts, p24 antigen levels, and, later, quantitative HIV-1 culture results were the only measures we had of the effectiveness of what we were later to learn was a minimally potent antiretroviral agent when used as monotherapy. We were desperate for better markers of antiviral response. A decade earlier, Tom and his group had discovered the usefulness of virus markers as a measure of the effect of interferon therapy for hepatitis B virus (HBV) [2]. Quantitation of circulating HBV

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Ethnicity and discordance in plasma HIV-1 RNA viral load and CD4+ lymphocyte count in a cohort of HIV-1-infected individuals

Cited by 24 publications

References 16 publications

Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care

Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care

Which method of adherence measurement is most suitable for daily use to predict virological failure among immigrant and non-immigrant HIV-1 infected patients?

HIV‐1 Load Quantitation: A 17‐Year Perspective

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