Understanding the disparity: predictors of virologic failure in women using highly active antiretroviral therapy vary by race and/or ethnicity.
Understanding the disparity: predictors of virologic failure in women using highly active antiretroviral therapy vary by race and/or ethnicity.
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DOI：
10.1097/qai.0b013e3182a095e9
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发表时间：
2013-11-01
期刊：
影响因子：
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通讯作者：
Women's Interagency HIV Study
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文献类型：
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作者：
McFall AM;Dowdy DW;Zelaya CE;Murphy K;Wilson TE;Young MA;Gandhi M;Cohen MH;Golub ET;Althoff KN;Women's Interagency HIV Study
在美国，艾滋病毒感染者的健康结果存在明显的种族/民族差异。国家艾滋病毒/艾滋病战略的三个主要目标之一是减少与艾滋病毒有关的差距和保健不公平现象。利用2006年4月至2011年3月参加妇女机构间艾滋病毒研究的艾滋病毒感染妇女的数据，我们测量了HAART抑制（HIV RNA <80拷贝/mL）后的病毒学失败（HIV RNA bb0 200拷贝/mL）。我们使用离散时间生存分析确定了病毒学失败的预测因子，并计算了种族/民族特异性人群归因分数（paf）。在887名符合条件的女性中，408名（46%）在研究期间经历了病毒学失败。西班牙裔和白人女性的病毒学失败风险显著低于非裔美国女性（西班牙裔风险比，HR=0.8, 95%可信区间[0.6,0.9]；白人风险比=0.7[0.5,0.9]）。西班牙裔妇女（aHR=2.2 [0.7, 6.5]， PAF=49%）和非裔美国妇女（aHR=1.8 [1.1, 3.2]， PAF=38%）与低收入相关的病毒学失败的人群归因比例高于白人妇女（aHR=1.4 [0.6, 3.4]， PAF=16%）。与公共健康保险相比，缺乏健康保险仅在西班牙裔妇女（aHR=2.0 [0.9, 4.6]， PAF=22%）和白人妇女（aHR=1.9 [0.7, 5.1]， PAF=13%）中与病毒学失败相关。相比之下，抑郁症状仅在非裔美国女性中与病毒学失败相关（aHR=1.6 [1.2, 2.2]， PAF=17%）。在接受治疗的艾滋病毒感染妇女群体中，病毒学失败是常见的，病毒学失败的相关因素因种族/民族而异。减少艾滋病毒治疗结果的种族/民族差异的战略应解决种族/民族特有的障碍，包括抑郁症和低收入，以维持病毒学抑制。
Stark racial/ethnic disparities in health outcomes exist among those living with HIV in the United States. One of three primary goals of the National HIV/AIDS Strategy is to reduce HIV-related disparities and health inequities. Using data from HIV-infected women participating in the Women’s Interagency HIV Study from April 2006 to March 2011, we measured virologic failure (HIV RNA >200 copies/mL) following suppression (HIV RNA <80 copies/mL) on HAART. We identified predictors of virologic failure using discrete-time survival analysis and calculated racial/ethnic-specific population attributable fractions (PAFs). Of 887 eligible women, 408 (46%) experienced virologic failure during the study period. Hispanic and White women had significantly lower hazards of virologic failure than African-American women (Hispanic hazard ratio, HR=0.8, 95% confidence interval [0.6, 0.9]; White HR=0.7 [0.5, 0.9]). The population attributable fraction of virologic failure associated with low income was higher in Hispanic (aHR=2.2 [0.7, 6.5], PAF=49%) and African-American women (aHR=1.8 [1.1, 3.2], PAF=38%) than among White women (aHR=1.4 [0.6, 3.4], PAF=16%). Lack of health insurance compared to public health insurance was associated with virologic failure only among Hispanic (aHR=2.0 [0.9, 4.6], PAF=22%) and White women (aHR=1.9 [0.7, 5.1], PAF=13%). By contrast, depressive symptoms were associated with virologic failure only among African-American women (aHR=1.6 [1.2, 2.2], PAF=17%). In this population of treated HIV-infected women, virologic failure was common, and correlates of virologic failure varied by race/ethnicity. Strategies to reduce disparities in HIV treatment outcomes by race/ethnicity should address racial/ethnic-specific barriers including depression and low income to sustain virologic suppression.