Effectiveness of highly-active antiretroviral therapy by race/ethnicity

被引:34
作者
Silverberg, Michael J.
Wegner, Scott A.
Milazzo, Mark J.
McKaig, Rosemary G.
Williams, Carolyn F.
Agan, Brian K.
Armstrong, Adam W.
Gange, Stephen J.
Hawkes, Clifton
O'Connell, Robert J.
Ahuja, Sunil K.
Dolan, Matthew J.
机构
[1] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
[2] TACC, NHS, Rockville, MD USA
[3] Walter Reed Army Med Ctr, Walter Reed Army Inst Res, Div Retrovirol, Washington, DC 20307 USA
[4] NIAID, Epidemiol Branch, Div AIDS, NIH,DHHS, Bethesda, MD 20892 USA
[5] Wilford Hall USAF Med Ctr, Dept Infect Dis, Lackland AFB, TX 78236 USA
[6] USN, Med Ctr, Portsmouth, VA USA
[7] Walter Reed Army Med Ctr, Washington, DC 20307 USA
[8] S Texas Vet Hlth Care Syst, Vet Adm Res Ctr Aids & HIV 1 Infect, San Antonio, TX USA
[9] Univ Texas Hlth Ctr, Dept Med, San Antonio, TX USA
[10] Def Inst Med Operat, Brooks AFB, TX USA
关键词
highly-active antiretroviral therapy; survival; AIDS; race/ethnicity; HIV seroconversion; effectiveness;
D O I
10.1097/01.aids.0000237369.41617.0f
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objective: To determine the effectiveness of HAART by race/ethnicity. Design: Prospective multicenter cohort study. Methods: We studied 991 African-Americans and 911 European-Americans enrolled in the United States Military's Tri-Service AIDS Clinical Consortium Natural History Study who had dates of HIV seroconversion known within 5 years and followed between 1990 and 2002. We determined the rate of disease progression to AIDS and death for subjects in this cohort. Multivariable models evaluated race, pre-HAART (1990-1995) and HAART (1996-2002) eras, age, gender and military service. Results: In the pre-HAART era, African-Americans had a statistically nonsignificant trend towards better outcomes: the relative hazards (RH) of AIDS and death for African-Americans compared to European-Americans were 0.85 [95% confidence interval (CI), 0.68-1.051 and 0.77 (95% CI, 0.55-1.08), respectively. In the HAART era, outcomes were similar by race: 1.17 (95% CI, 0.86-1.61) for AIDS and 1.11 (95% CI, 0.81-1.53) for death with overlapping Kaplan-Meier curves. Relative to the pre-HAART era, the adjusted RH of AIDS in the HAART era was 0.41 (95% CI, 0.31-0.54) and 0.30 (95% CI, 0.22-0.40) for African-American and European-American participants, respectively. Analogous RH for death were 0.55 (95% CI, 0.38-0.80) and 0.38 (95% CI, 0.27-0.54). The precipitous declines in AIDS and death in the HAART era were not statistically different by race. Conclusions: In a large multi-racial cohort with equal access to health care, HIV treatment outcomes by race/ethnicity were similar. (c) 2006 Lippincott Williams & Wilkins.
引用
收藏
页码:1531 / 1538
页数:8
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