Race/ethnicity and HAART initiation in a military HIV infected cohort

Erica N. Johnson; Mollie P. Roediger; Michael L. Landrum; Nancy F. Crum-Cianflone; Amy C. Weintrob; Anuradha Ganesan; Jason F. Okulicz; Grace E. Macalino; Brian K. Agan; M. Kortepeter; C. Decker; S. Fraser; J. Hartzell; R. Ressner; P. Waterman; T. Warkentien; T. Whitman; G. Wortmann; M. Zapor; T. Lalani; S. Merritt; M. Bavaro; H. Chun; G. Hsue; A. Johnson; C. Eggleston; R. O'Connell; S. Peel; M. Polis; J. Powers; E. Tramont

doi:10.1186/1742-6405-11-10

Race/ethnicity and HAART initiation in a military HIV infected cohort

Erica N. Johnson, Mollie P. Roediger, Michael L. Landrum, Nancy F. Crum-Cianflone, Amy C. Weintrob, Anuradha Ganesan, Jason F. Okulicz, Grace E. Macalino, Brian K. Agan, M. Kortepeter, C. Decker, S. Fraser, J. Hartzell, R. Ressner, P. Waterman, T. Warkentien, T. Whitman, G. Wortmann, M. Zapor, T. LalaniS. Merritt, M. Bavaro, H. Chun, G. Hsue, A. Johnson, C. Eggleston, R. O'Connell, S. Peel, M. Polis, J. Powers, E. Tramont

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Background: Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity.Methods: Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 <200, AIDS event or severe symptoms; Group A), an indication to consider HAART (including CD4 <350; Group B) or electively started HAART (CD4 >350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count <200 cells/mm³. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR).Results: 1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94% male, 46% African American, 40% Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk.Conclusions: No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.

Original language	English (US)
Article number	10
Journal	AIDS research and therapy
Volume	11
Issue number	1
DOIs	https://doi.org/10.1186/1742-6405-11-10
State	Published - Jan 24 2014
Externally published	Yes

Keywords

African Americans
Disparities in care
Ethnicity
HAART
HIV
Indications for HIV treatment
Race

ASJC Scopus subject areas

Molecular Medicine
Virology
Pharmacology (medical)

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10.1186/1742-6405-11-10

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Johnson, E. N., Roediger, M. P., Landrum, M. L., Crum-Cianflone, N. F., Weintrob, A. C., Ganesan, A., Okulicz, J. F., Macalino, G. E., Agan, B. K., Kortepeter, M., Decker, C., Fraser, S., Hartzell, J., Ressner, R., Waterman, P., Warkentien, T., Whitman, T., Wortmann, G., Zapor, M., ... Tramont, E. (2014). Race/ethnicity and HAART initiation in a military HIV infected cohort. AIDS research and therapy, 11(1), Article 10. https://doi.org/10.1186/1742-6405-11-10

Johnson, EN, Roediger, MP, Landrum, ML, Crum-Cianflone, NF, Weintrob, AC, Ganesan, A, Okulicz, JF, Macalino, GE, Agan, BK, Kortepeter, M, Decker, C, Fraser, S, Hartzell, J, Ressner, R, Waterman, P, Warkentien, T, Whitman, T, Wortmann, G, Zapor, M, Lalani, T, Merritt, S, Bavaro, M, Chun, H, Hsue, G, Johnson, A, Eggleston, C, O'Connell, R, Peel, S, Polis, M, Powers, J & Tramont, E 2014, 'Race/ethnicity and HAART initiation in a military HIV infected cohort', AIDS research and therapy, vol. 11, no. 1, 10. https://doi.org/10.1186/1742-6405-11-10

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title = "Race/ethnicity and HAART initiation in a military HIV infected cohort",

abstract = "Background: Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity.Methods: Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 <200, AIDS event or severe symptoms; Group A), an indication to consider HAART (including CD4 <350; Group B) or electively started HAART (CD4 >350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count <200 cells/mm3. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR).Results: 1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94% male, 46% African American, 40% Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk.Conclusions: No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.",

keywords = "African Americans, Disparities in care, Ethnicity, HAART, HIV, Indications for HIV treatment, Race",

author = "Johnson, {Erica N.} and Roediger, {Mollie P.} and Landrum, {Michael L.} and Crum-Cianflone, {Nancy F.} and Weintrob, {Amy C.} and Anuradha Ganesan and Okulicz, {Jason F.} and Macalino, {Grace E.} and Agan, {Brian K.} and M. Kortepeter and C. Decker and S. Fraser and J. Hartzell and R. Ressner and P. Waterman and T. Warkentien and T. Whitman and G. Wortmann and M. Zapor and T. Lalani and S. Merritt and M. Bavaro and H. Chun and G. Hsue and A. Johnson and C. Eggleston and R. O'Connell and S. Peel and M. Polis and J. Powers and E. Tramont",

note = "Funding Information: Support for this work (IDCRP-000-13) was provided by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences. This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072. We would like to express our gratitude to the current members of the IDCRP HIV Working Group and the long line of military HIV researchers who have supported the HIV NHS and for the research coordinators and support staff for their countless hours of work. Most importantly, we would like to thank the volunteers for their participation, without which this research would not have been possible. Members of the IDCRP HIV Working Group in addition to the Authors: Uniformed Services University of the Health Sciences, Bethesda, MD-M. Kortepeter; Walter Reed National Military Medical Center Bethesda, Bethesda, MD - C. Decker, S. Fraser, J. Hartzell, R. Ressner, P. Waterman, T. Warkentien, T. Whitman, G. Wortmann, M. Zapor; Naval Medical Center, Portsmouth, VAT. Lalani; San Antonio Military Medical Center, San Antonio, TX-S. Merritt; Naval Medical Center, San Diego, CAM. Bavaro, H. Chun; Tripler Army Medical Center, Honolulu, HI-G. Hsue, A. Johnson; Walter Reed Army Institute of Research, Silver Spring, MD-C. Eggleston, R. O{\textquoteright}Connell, S. Peel; National Institute of Allergy and Infectious Diseases, Bethesda, MD-M. Polis, J. Powers, E. Tramont.",

year = "2014",

month = jan,

day = "24",

doi = "10.1186/1742-6405-11-10",

language = "English (US)",

volume = "11",

journal = "AIDS research and therapy",

issn = "1742-6405",

publisher = "BioMed Central",

number = "1",

}

TY - JOUR

T1 - Race/ethnicity and HAART initiation in a military HIV infected cohort

AU - Johnson, Erica N.

AU - Roediger, Mollie P.

AU - Landrum, Michael L.

AU - Crum-Cianflone, Nancy F.

AU - Weintrob, Amy C.

AU - Ganesan, Anuradha

AU - Okulicz, Jason F.

AU - Macalino, Grace E.

AU - Agan, Brian K.

AU - Kortepeter, M.

AU - Decker, C.

AU - Fraser, S.

AU - Hartzell, J.

AU - Ressner, R.

AU - Waterman, P.

AU - Warkentien, T.

AU - Whitman, T.

AU - Wortmann, G.

AU - Zapor, M.

AU - Lalani, T.

AU - Merritt, S.

AU - Bavaro, M.

AU - Chun, H.

AU - Hsue, G.

AU - Johnson, A.

AU - Eggleston, C.

AU - O'Connell, R.

AU - Peel, S.

AU - Polis, M.

AU - Powers, J.

AU - Tramont, E.

N1 - Funding Information: Support for this work (IDCRP-000-13) was provided by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences. This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072. We would like to express our gratitude to the current members of the IDCRP HIV Working Group and the long line of military HIV researchers who have supported the HIV NHS and for the research coordinators and support staff for their countless hours of work. Most importantly, we would like to thank the volunteers for their participation, without which this research would not have been possible. Members of the IDCRP HIV Working Group in addition to the Authors: Uniformed Services University of the Health Sciences, Bethesda, MD-M. Kortepeter; Walter Reed National Military Medical Center Bethesda, Bethesda, MD - C. Decker, S. Fraser, J. Hartzell, R. Ressner, P. Waterman, T. Warkentien, T. Whitman, G. Wortmann, M. Zapor; Naval Medical Center, Portsmouth, VAT. Lalani; San Antonio Military Medical Center, San Antonio, TX-S. Merritt; Naval Medical Center, San Diego, CAM. Bavaro, H. Chun; Tripler Army Medical Center, Honolulu, HI-G. Hsue, A. Johnson; Walter Reed Army Institute of Research, Silver Spring, MD-C. Eggleston, R. O’Connell, S. Peel; National Institute of Allergy and Infectious Diseases, Bethesda, MD-M. Polis, J. Powers, E. Tramont.

PY - 2014/1/24

Y1 - 2014/1/24

N2 - Background: Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity.Methods: Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 <200, AIDS event or severe symptoms; Group A), an indication to consider HAART (including CD4 <350; Group B) or electively started HAART (CD4 >350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count <200 cells/mm3. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR).Results: 1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94% male, 46% African American, 40% Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk.Conclusions: No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.

AB - Background: Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity.Methods: Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 <200, AIDS event or severe symptoms; Group A), an indication to consider HAART (including CD4 <350; Group B) or electively started HAART (CD4 >350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count <200 cells/mm3. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR).Results: 1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94% male, 46% African American, 40% Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk.Conclusions: No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.

KW - African Americans

KW - Disparities in care

KW - Ethnicity

KW - HAART

KW - HIV

KW - Indications for HIV treatment

KW - Race

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DO - 10.1186/1742-6405-11-10

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C2 - 24460764

AN - SCOPUS:84892722708

SN - 1742-6405

VL - 11

JO - AIDS research and therapy

JF - AIDS research and therapy

IS - 1

M1 - 10

ER -

Race/ethnicity and HAART initiation in a military HIV infected cohort

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