October 28, 2009

Hispanics Might Have Poorer HIV Survival

Survival rates might be lowest among Hispanic men and women who either start antiretroviral (ARV) therapy late or discontinue it early, according to a study published November 15 in Clinical Infectious Diseases.

Much has been written about the lingering risks of illness and death among people who don’t start ARV treatment until their HIV disease has already progressed. This remains a significant problem in about 25 percent of those living with HIV, who don’t find out they are infected with the virus until they have a low CD4 cell count or have already developed an AIDS-related complication. Whether morbidity and mortality rates associated with late treatment are even more pronounced among certain racial groups hasn’t been established.  

Questions also remain about rates of disease progression and death among people who abruptly discontinue ARV therapy, again stratified by race.

To evaluate the possibility of such racial disparities, Elena Losina, PhD, from Harvard University Center for AIDS Research in Cambridge, Massachusetts, and her colleagues ran computer simulations involving data from the cohort-driven HIV Research Network. The HIV Research Network is able to track basic demographics, people’s CD4 counts when they enter care, and the likelihood that they will stop taking ARV treatment altogether after the failure of a treatment regimen.

Assuming a starting point of 33 years old, the average HIV-negative person would live an additional 42.91 years according to the computer simulations. After accounting for a number of risk factors known to affect survival among people living with HIV—such as race, poverty and drug use—the average HIV-negative person with these same risks would be expected to die eight years prematurely.  

An HIV-positive person who starts ARV treatment according to current treatment guidelines—when the CD4 count reaches 350—would likely survive 22 fewer years than the average HIV-negative person with no other health risks. Starting treatment later, or discontinuing treatment early, shaved off an additional 3.9 years of life.

It is important to remember that these numbers are averages, based on computer simulations, and cannot be applied to any individual person living with HIV—and the researchers clearly state that they do not intend for the data to be used this way. Rather, these simulations were conducted to determine the possible consequences of late treatment initiation and early discontinuation as well as the impact of race and gender on estimated survival. Also, the life expectancy calculations in this study are a bit lower than in several other published studies.

To that end, based on trends observed in the HIV Research Network, Hispanic men lost the greatest potential number of years because of late starting, or early stopping, of treatment, followed closely by Hispanic women. Differences in survival were more similar between black and white patients. HIV-positive black male patients had slightly better projected survival than white male patients, and black female patients had slightly worse projections for years of life lost than white women. Overall, women had worse projected outcomes than men.

The authors conclude that further research needs to be conducted to determine whether initiatives to increase testing and improve early access to HIV care will decrease the race and gender disparities they found in their study.

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