Disparities in Outcomes for African American and Latino Subjects in the Flexible Initial Retrovirus Suppressive Therapies (FIRST) Trial
Disparities in Outcomes for African American and Latino Subjects in the Flexible Initial Retrovirus Suppressive Therapies (FIRST) Trial
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DOI：
10.1089/apc.2009.0332
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发表时间：
2010-05-01
影响因子：
4.9
通讯作者：
MacArthur, Rodger D.
中科院分区：
文献类型：
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作者：
Giordano, Thomas P.;Bartsch, Glenn;MacArthur, Rodger D.
为了最大限度地受益于抗逆转录病毒治疗，艾滋病毒感染患者必须在病情进展之前进入护理，并坚持护理。我们试图确定在这一连续护理体系中是否以及在哪里存在明显的种族/族裔差异。来自灵活的初始逆转录病毒抑制疗法(FIRST)试验的数据评估了三种初始艾滋病毒治疗策略，并对白人、非裔美国人和拉丁裔受试者进行了比较。结果包括疾病和死亡的进展，艾滋病毒病毒抑制，以及CD4(+)细胞计数的变化。对已知的生存预测因素进行调整的多变量Cox比例风险模型。共有1357名受试者，其中包括368名非拉丁裔白人，751名非拉丁裔非裔美国人和238名拉丁裔受试者。在基线上，后两组人更有可能患有艾滋病，并且比白人受试者的CD4(+)细胞计数更低。在随访中，非裔美国人受试者自我报告的治疗依从性较低，CD4(+)细胞计数增加较少，病毒抑制的几率较低。非洲裔美国人和拉丁裔受试者的疾病进展或死亡的未调整危险比分别为1.57(1.17，2.10；p-0.0025)和1.57(1.09，2.26；p-0.02)。调整基线差异和依从性差异、CD4(+)细胞计数变化和病毒抑制可以解释结果的差异。在艾滋病毒护理的连续过程中，存在着减少非洲裔美国人和拉丁裔患者结局差异的机会。促进获得艾滋病毒检测和护理以及改善遵守情况的努力有可能减少艾滋病毒感染者结局中的种族/族裔差异。
To benefit maximally from antiretroviral therapy, patients with HIV infection must enter care before their disease is advanced and adhere to care. We sought to determine if and where on this continuum of care racial/ethnic disparities were evident. Data from the Flexible Initial Retrovirus Suppressive Therapies (FIRST) trial, which evaluated three strategies for initial HIV therapy, were compared for White, African American, and Latino subjects. Outcomes included progression of disease and death, HIV viral suppression, and change in CD4(+) cell count. Multivariate Cox proportional hazard models adjusted for known predictors of survival. There were 1357 subjects, including 368 non-Latino white, 751 non-Latino African American, and 238 Latino subjects. At baseline, the two latter groups were more likely to have had AIDS and had lower CD4(+) cell counts than white subjects. In follow-up, African American subjects had lower self-reported adherence to therapy, lower CD4(+) cell count increases, and lower odds of viral suppression. African American and Latino subjects had unadjusted hazard ratios of progression of disease or death of 1.57 (1.17, 2.10; p - 0.0025) and 1.57 (1.09, 2.26; p - 0.02), respectively. Adjusting for baseline differences and differences in adherence, CD4(+) cell count change, and viral suppression accounted for the disparities in outcomes. Opportunities to reduce disparities in outcomes for African American and Latino patients exist along the continuum of HIV care. Efforts to promote access to HIV testing and care and to improve adherence have the potential to reduce racial/ethnic disparities in outcomes of patients with HIV infection.