Black US Women on ART Have Higher AIDS Death Rate Than White Women

HIV-positive African-American women taking antiretroviral therapy (ART) and enrolled in a large US prospective study had a higher rate of death from AIDS and new AIDS-defining illnesses than white women. Socioeconomic and cultural differences may distinguish black from white HIV-positive women in the United States, even when they are part of the same study group, such as the Women's Interagency HIV Study (WIHS). WIHS enrolled HIV-positive and at-risk women in five US cities in 1994-1995 and 2001-2002. Study participants make twice-yearly visits for interviews and testing.

In this analysis involving 1471 continuous ART users, researchers measured time to AIDS death, non-AIDS death, and new AIDS-defining illnesses in WIHS women from the time they started ART.

Statistical analysis adjusted for potential AIDS and death risk factors determined that black women had more than a doubled risk of AIDS death compared with white women (adjusted hazard ratio [aHR] 2.14, 95% confidence interval [CI] 1.30 to 3.50, P = 0.003). In an analysis also adjusted for time-updated ART adherence, black women had a tripled risk of AIDS death (aHR 3.09, 95% CI 1.38 to 6.93, P = 0.006).

Compared with white women, black women had almost a 60% higher risk of a new AIDS diagnosis (aHR 1.58, 95% CI 1.08 to 2.32, P = 0.02). Non-AIDS death risk did not differ significantly between black and white women (aHR 0.91, 95% CI 0.59 to 1.39, P = 0.65).

Several other pre-ART factors were independently associated with a higher AIDS death risk, at the following adjusted hazard ratios (and 95% CIs):

• Peak viral load: aHR 1.70 per 10-fold higher (1.34 to 2.16, P  <  0.001)

• Depressive symptoms: aHR 2.10 (1.51 to 2.92, P  <  0.001)

• Hepatitis C virus infection: aHR 1.57 (1.02 to 2.40, P  =  0.04)

• HIV acquisition via transfusion: aHR 2.33 (1.21 to 4.49, P  =  0.01)

Every 100-cell higher nadir CD4 count independently lowered the risk of AIDS death 35% (aHR 0.65 per 100  cells higher, 95% CI 0.56 to 0.76, P  <  0.001).

"In continuous HAART-using women," the WIHS team concludes, "black women more rapidly died from AIDS or experienced incident AIDS-defining illness than their white counterparts after adjusting for confounders." Persistence of these associations after statistical adjustment for antiretroviral adherence indicates that adherence does not play an important role in these higher risks, at least not in this study group.

Source: Kerry Murphy, Donald R. Hoover, Qiuhu Shi, Mardge Cohen, Monica Gandhi, Elizabeth T. Golub, Deborah R. Gustafson, Celeste Leigh Pearce, Mary Young, Kathryn Anastos. Association of self-reported race with AIDS death in continuous HAART users in a cohort of HIV-infected women in the United States. AIDS. 2013; 27: 2413-2423.

Written by Mark Mascolini on behalf of the International AIDS Society