| Race/ethnicity and risk of AIDS and death among HIV-infected patients with access to care. | |
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MedLine Citation:
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PMID: 19609624 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Michael J Silverberg; Wendy Leyden; Charles P Quesenberry; Michael A Horberg |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2009-07-16 |
Journal Detail:
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Title: Journal of general internal medicine Volume: 24 ISSN: 1525-1497 ISO Abbreviation: J Gen Intern Med Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-08-14 Completed Date: 2010-04-30 Revised Date: 2010-09-02 |
Medline Journal Info:
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Nlm Unique ID: 8605834 Medline TA: J Gen Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 1065-72 Citation Subset: IM |
Affiliation:
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Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA. Michael.J.Silverberg@kp.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acquired Immunodeficiency Syndrome
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ethnology*,
mortality*,
therapy Adult Anti-Retroviral Agents / therapeutic use Cohort Studies Continental Population Groups / ethnology* Ethnic Groups / ethnology* Female Follow-Up Studies HIV Infections / ethnology, mortality, therapy Health Services Accessibility / trends Healthcare Disparities / trends Humans Male Middle Aged Mortality / trends Retrospective Studies Risk Factors Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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K01AI071725/AI/NIAID NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Anti-Retroviral Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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