International AIDS Society

Disparities in HIV Care Outcomes Disappearing in Diverse US Clinic

Author: Mark Mascolini

29 September 2012

“As of calendar year 2010, there is no difference by demographic or behavioral risk groups in ART [antiretroviral therapy] prescription, OI [opportunistic infection] rates, or mortality rates” at the Johns Hopkins HIV clinic in Baltimore, Maryland, which serves high numbers of blacks, poor people, and injection drug users (IDUs).

Despite advances in ART access and response to ART across the United States, several research groups have demonstrated disparities in rates of comorbidity and mortality by race, sex, and HIV transmission risk group. But a recent analysis by the US HIV Outpatient Study (HOPS) group found no mortality difference by race for patients with a CD4 count above 200 cells/µL.

Johns Hopkins investigators analyzed 6366 HIV-positive patients in their inner-city HIV practice, which includes high proportions of poor people, blacks, and IDUs. The researchers compared use of combination ART, viral load, CD4 count, OI incidence, and mortality from 1995 to 2010 by HIV risk group, sex, and race (black versus white).

By 2010 a large majority of clinic patients, 87%, was taking ART, median viral load lay below 200 copies/mL, and median CD4 count stood at 475 cells/µL. The OI rate was 2.4 per 100 person-years, and mortality was 2.1 per 100 person-years (meaning about 2 out of every 100 people died every year).

The only outcome differences involved IDUs, who had a 79-cell/µL lower CD4 count and a 0.16 log higher viral load than other transmission risk groups. Although these differences were statistically significant (P < 0.01), they had no measurable impact on OI rates or mortality. There were no race- or sex-based differences. In 2009 a 28-year-old HIV-positive person in the clinic had a projected 45.4 additional years to live, approaching the normal lifespan of people without HIV.

The Johns Hopkins team believes these improvements probably reflect “the remarkable advances in the development of ART, coupled with continual improvements in the management of HIV-infected individuals based on evidence-based guidelines.”

They credit the Ryan White HIV/AIDS Program, a national financial support program for HIV-positive people, with helping clinicians “to address the challenge to deliver treatment that is highly effective, but also expensive, complex, and requires continuous patient engagement.”

Source: Richard D. Moore, Jeanne C. Keruly, John G. Bartlett. Improvement in the health of HIV-infected persons in care: reducing disparities. Clinical Infectious Diseases. 2012. Online head of print. DOI: 10.1093/cid/cis654.

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