Association of self-reported race with AIDS death in continuous HAART users in a cohort of HIV-infected women in the United States

Kerry J. Murphy, Donald R. Hoover, Qiuhu Shi, Mardge Cohen, Monica Gandhi, Elizabeth T. Golub, Deborah R. Gustafson, Celeste Leigh Pearce, Mary Young, Kathryn Anastos

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective: To assess the association of race with clinical outcomes in HIV-positive women on continuous HAART. Design: Prospective study that enrolled women from 1994 to 1995 and 2001 to 2002. Setting: Women's Interagency HIV Study, a community-based cohort in five US cities. Participants: One thousand, four hundred and seventy-one HIV-positive continuous HAART users. Main outcome measures: Times to AIDS and non-AIDS death and incident AIDSdefining illness (ADI) after HAART initiation. Results: In adjusted analyses, black vs. white women had higher rates of AIDS death [adjusted hazard ratio (aHR) 2.14, 95% confidence interval (CI) 1.30, 3.50; P=0.003] and incident ADI (aHR 1.58, 95% CI 1.08, 2.32; P=0.02), but not non-AIDS death (aHR 0.91, 95% CI 0.59, 1.39; P=0.65). Cumulative AIDS death incidence at 10 years was 17.3 and 8.3% for black and white women, respectively. Other significant independent pre-HAART predictors of AIDS death included peak viral load (aHR 1.70 per log10, 95% CI 1.34, 2.16; P<0.001), nadir CD4+ cell count (aHR 0.65 per 100 cells/ml, 95% CI 0.56, 0.76; P<0.001), depressive symptoms by Center for Epidemiology Studies Depression score at least 16 (aHR 2.10, 95% CI 1.51, 2.92; P<0.001), hepatitis C virus infection (aHR 1.57, 95% CI 1.02, 2.40; P=0.04), and HIV acquisition via transfusion (aHR 2.33, 95% CI 1.21, 4.49; P=0.01). In models with time-updated HAART adherence, association of race with AIDS death remained statistically significant (aHR 3.09, 95% CI 1.38, 6.93; P=0.006). Conclusion: In continuous HAART-using women, black women more rapidly died from AIDS or experienced incident ADI than their white counterparts after adjusting for confounders. Future studies examining behavioral and biologic factors in these women may further the understanding of HAART prognosis.

Original languageEnglish (US)
Pages (from-to)2413-2423
Number of pages11
JournalAIDS
Volume27
Issue number15
DOIs
StatePublished - Sep 24 2013

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Highly Active Antiretroviral Therapy
Acquired Immunodeficiency Syndrome
HIV
Confidence Intervals
Depression
Biological Factors
Virus Diseases
CD4 Lymphocyte Count
Viral Load
Hepacivirus
Epidemiology
Outcome Assessment (Health Care)
Prospective Studies
Mortality
Incidence

Keywords

  • AIDS
  • HAART
  • HIV
  • Race
  • Survival
  • Women

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Association of self-reported race with AIDS death in continuous HAART users in a cohort of HIV-infected women in the United States. / Murphy, Kerry J.; Hoover, Donald R.; Shi, Qiuhu; Cohen, Mardge; Gandhi, Monica; Golub, Elizabeth T.; Gustafson, Deborah R.; Pearce, Celeste Leigh; Young, Mary; Anastos, Kathryn.

In: AIDS, Vol. 27, No. 15, 24.09.2013, p. 2413-2423.

Research output: Contribution to journalArticle

Murphy, Kerry J. ; Hoover, Donald R. ; Shi, Qiuhu ; Cohen, Mardge ; Gandhi, Monica ; Golub, Elizabeth T. ; Gustafson, Deborah R. ; Pearce, Celeste Leigh ; Young, Mary ; Anastos, Kathryn. / Association of self-reported race with AIDS death in continuous HAART users in a cohort of HIV-infected women in the United States. In: AIDS. 2013 ; Vol. 27, No. 15. pp. 2413-2423.
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abstract = "Objective: To assess the association of race with clinical outcomes in HIV-positive women on continuous HAART. Design: Prospective study that enrolled women from 1994 to 1995 and 2001 to 2002. Setting: Women's Interagency HIV Study, a community-based cohort in five US cities. Participants: One thousand, four hundred and seventy-one HIV-positive continuous HAART users. Main outcome measures: Times to AIDS and non-AIDS death and incident AIDSdefining illness (ADI) after HAART initiation. Results: In adjusted analyses, black vs. white women had higher rates of AIDS death [adjusted hazard ratio (aHR) 2.14, 95{\%} confidence interval (CI) 1.30, 3.50; P=0.003] and incident ADI (aHR 1.58, 95{\%} CI 1.08, 2.32; P=0.02), but not non-AIDS death (aHR 0.91, 95{\%} CI 0.59, 1.39; P=0.65). Cumulative AIDS death incidence at 10 years was 17.3 and 8.3{\%} for black and white women, respectively. Other significant independent pre-HAART predictors of AIDS death included peak viral load (aHR 1.70 per log10, 95{\%} CI 1.34, 2.16; P<0.001), nadir CD4+ cell count (aHR 0.65 per 100 cells/ml, 95{\%} CI 0.56, 0.76; P<0.001), depressive symptoms by Center for Epidemiology Studies Depression score at least 16 (aHR 2.10, 95{\%} CI 1.51, 2.92; P<0.001), hepatitis C virus infection (aHR 1.57, 95{\%} CI 1.02, 2.40; P=0.04), and HIV acquisition via transfusion (aHR 2.33, 95{\%} CI 1.21, 4.49; P=0.01). In models with time-updated HAART adherence, association of race with AIDS death remained statistically significant (aHR 3.09, 95{\%} CI 1.38, 6.93; P=0.006). Conclusion: In continuous HAART-using women, black women more rapidly died from AIDS or experienced incident ADI than their white counterparts after adjusting for confounders. Future studies examining behavioral and biologic factors in these women may further the understanding of HAART prognosis.",
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AU - Gandhi, Monica

AU - Golub, Elizabeth T.

AU - Gustafson, Deborah R.

AU - Pearce, Celeste Leigh

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N2 - Objective: To assess the association of race with clinical outcomes in HIV-positive women on continuous HAART. Design: Prospective study that enrolled women from 1994 to 1995 and 2001 to 2002. Setting: Women's Interagency HIV Study, a community-based cohort in five US cities. Participants: One thousand, four hundred and seventy-one HIV-positive continuous HAART users. Main outcome measures: Times to AIDS and non-AIDS death and incident AIDSdefining illness (ADI) after HAART initiation. Results: In adjusted analyses, black vs. white women had higher rates of AIDS death [adjusted hazard ratio (aHR) 2.14, 95% confidence interval (CI) 1.30, 3.50; P=0.003] and incident ADI (aHR 1.58, 95% CI 1.08, 2.32; P=0.02), but not non-AIDS death (aHR 0.91, 95% CI 0.59, 1.39; P=0.65). Cumulative AIDS death incidence at 10 years was 17.3 and 8.3% for black and white women, respectively. Other significant independent pre-HAART predictors of AIDS death included peak viral load (aHR 1.70 per log10, 95% CI 1.34, 2.16; P<0.001), nadir CD4+ cell count (aHR 0.65 per 100 cells/ml, 95% CI 0.56, 0.76; P<0.001), depressive symptoms by Center for Epidemiology Studies Depression score at least 16 (aHR 2.10, 95% CI 1.51, 2.92; P<0.001), hepatitis C virus infection (aHR 1.57, 95% CI 1.02, 2.40; P=0.04), and HIV acquisition via transfusion (aHR 2.33, 95% CI 1.21, 4.49; P=0.01). In models with time-updated HAART adherence, association of race with AIDS death remained statistically significant (aHR 3.09, 95% CI 1.38, 6.93; P=0.006). Conclusion: In continuous HAART-using women, black women more rapidly died from AIDS or experienced incident ADI than their white counterparts after adjusting for confounders. Future studies examining behavioral and biologic factors in these women may further the understanding of HAART prognosis.

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