571. In a Well Characterized Cohort with Universal Access to Care and Medications Racial Disparities in HIV Virologic Outcomes are No Longer Observed
Session: Poster Abstract Session: HIV: Linkage to Care and Viral Suppression in the Care Cascade
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Ganesan_ID Week Poster_uploaded version.pdf (532.1 kB)
  • Background: HIV-infected African-Americans [AA] are more likely to experience virologic failure (VF) compared with other ethnic groups. Decreased access to health care has been postulated as a potential cause. Using data from the US Military Natural History Study (NHS), we examined the effects of race on VF. The NHS is a longitudinal cohort comprised of Department of Defense (DoD) beneficiaries with unrestricted access to healthcare.

    Methods: We included NHS participants who contributed follow up after 2001. Demographic characteristics, antiretroviral therapy (ART) history, and serial viral loads [VL] were obtained from the database. Pharmacy records were used to calculate adherence. VF was defined as a VL of ³200 copies/mL on 2 consecutive measurements or one VL of >1000 c/mL. A Cox model with time-updated covariates was used to examine the association between race and VF.

    Results: 1,521 subjects contributed follow up after 2001 (41% AA; 95% male). Median age, CD4 count and VL at ART initiation [AI] were 31.6 years [IQR 26-39], 367 cells/ul [IQR 271-489] & 4.6 log10 copies/mL [IQR 4.0-5.0] respectively. Subjects were followed for a median of 4.8 years [IQR 2.7-7.9], and 13.2% (n=201) met criteria for VF. Most subjects initiated ART with a non-nucleoside reverse transcriptase inhibitor [NNRTI] (64%), integrase strand transferase inhibitor [InSTI] (15%) or a boosted Protease Inhibitor [PI] (14%) based regimen. Results of the adjusted Cox model are in the table below.

    Conclusion: In the NHS, in recent years, AA and Caucasians have similar responses to ART. NNRTI and InsTI use was protective, reinforcing that simpler medications with fewer adverse effects improve outcomes. Unrestricted access to care and modernization of ART should help narrow the disparities observed in virologic outcomes.

    Characteristics

    HR (95% CI)

    Race

    African- American

    Caucasian

    Hispanic/Other

    Ref

    0.78 (0.54-1.13)

    0.70 (0.44-1.11)

    Age* (per 10-year)

    0.63 (0.50-0.79)

    VL at ART (per log10)

    1.27 (1.05-1.54)

    HIV Dx to AI* (per 5-year)

    1.25 (0.99-1.57)

    Use of antiretrovirals before ART

    1.95 (1.19-3.21)

    CD4 count* (per 100-cell)

    0.93 (0.87-1.00)

    ART regimen*

    Boosted PI

    InSTI

    NNRTI

    Other Combinations

    Ref

    0.36 (0.16-0.77)

    0.55 (0.35-0.86)

    1.35 (0.79-2.29)

    Adherence > 90% vs ≤ 90%

    0.28 (0.20-0.41)

    *Time-updated covariate

    Anuradha Ganesan, MD, MPH1,2,3, Seunghyun Won, PhD4, Christie Joya, DO2, Robert Deiss, MD1,4,5, Ryan Maves, MD, FCCP, FIDSA5, Karl Kronmann, MD, MPH6, Tahaniyat Lalani, MBBS, MHS1,4,6, Christina Schofield, MD FACP, FIDSA7, Timothy J. Whitman, DO8, Jason Okulicz, MD9 and Brian Agan, MD1,4, (1)Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, (2)Infectious Disease, Walter Reed National Military Medical Center, Bethesda, MD, (3)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (4)Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, (5)Infectious Diseases, Naval Medical Center San Diego, San Diego, CA, (6)Naval Medical Center Portsmouth, Portsmouth, VA, (7)Madigan Army Medical Center, Tacoma, WA, (8)Walter Reed National Military Medical Center, Bethesda, MD, (9)Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, TX

    Disclosures:

    A. Ganesan, None

    S. Won, None

    C. Joya, None

    R. Deiss, None

    R. Maves, None

    K. Kronmann, None

    T. Lalani, None

    C. Schofield, None

    T. J. Whitman, None

    J. Okulicz, None

    B. Agan, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.