Rageshri Dhairyawan1, Hajra Okhai2, Teresa Hill2, Caroline A Sabin2,3. 1. Department of Infection and Immunity, Barts Health NHS Trust. 2. Institute for Global Health. 3. National Institute for Health Research Health Protection Research Unit in Blood-Borne and Sexually Transmitted Infections, University College London, London, UK.
Abstract
OBJECTIVE: We investigated differences in clinical outcomes in heterosexual participants, by ethnicity in the UK Collaborative HIV Cohort Study from 2000 to 2017. DESIGN: Cohort analysis. METHODS: Logistic/proportional hazard regression assessed ethnic group differences in CD4+ cell count at presentation, engagement-in-care, combination antiretroviral therapy (cART) initiation, viral suppression and rebound. RESULTS: Of 12 302 participants [median age: 37 (interquartile range: 31-44) years, 52.5% women, total follow-up: 85 846 person-years], 64.4% were black African, 19.1% white, 6.3% black Caribbean, 3.6% black other, 3.3% South Asian/other Asian and 3.4% other/mixed. CD4+ cell count at presentation amongst participants from non-white groups were lower than the white group. Participants were engaged-in-care for 79.6% of follow-up time; however, black and other/mixed groups were less likely to be engaged-in-care than the white group (adjusted odds ratios vs. white: black African: 0.70 (95% confidence interval (CI) 0.63-0.79], black Caribbean: 0.74 (0.63-0.88), other/mixed: 0.78 (0.62-0.98), black other: 0.81 (0.64-1.02)). Of 8867 who started cART, 79.1% achieved viral suppression, with no differences by ethnicity in cART initiation or viral suppression. Viral rebound (22.2%) was more common in the black other [1.95 (1.37-2.77)], black African [1.85 (1.52-2.24)], black Caribbean [1.73 (1.28-2.33)], South Asian/other Asian [1.35 (0.90-2.03)] and other/mixed [1.09 (0.69-1.71)] groups than in white participants. CONCLUSION: Heterosexual people from black, Asian and minority ethnic (BAME) groups presented with lower CD4+ cell counts, spent less time engaged-in-care and were more likely to experience viral rebound than white people. Work to understand and address these differences is needed.
OBJECTIVE: We investigated differences in clinical outcomes in heterosexual participants, by ethnicity in the UK Collaborative HIV Cohort Study from 2000 to 2017. DESIGN: Cohort analysis. METHODS: Logistic/proportional hazard regression assessed ethnic group differences in CD4+ cell count at presentation, engagement-in-care, combination antiretroviral therapy (cART) initiation, viral suppression and rebound. RESULTS: Of 12 302 participants [median age: 37 (interquartile range: 31-44) years, 52.5% women, total follow-up: 85 846 person-years], 64.4% were black African, 19.1% white, 6.3% black Caribbean, 3.6% black other, 3.3% South Asian/other Asian and 3.4% other/mixed. CD4+ cell count at presentation amongst participants from non-white groups were lower than the white group. Participants were engaged-in-care for 79.6% of follow-up time; however, black and other/mixed groups were less likely to be engaged-in-care than the white group (adjusted odds ratios vs. white: black African: 0.70 (95% confidence interval (CI) 0.63-0.79], black Caribbean: 0.74 (0.63-0.88), other/mixed: 0.78 (0.62-0.98), black other: 0.81 (0.64-1.02)). Of 8867 who started cART, 79.1% achieved viral suppression, with no differences by ethnicity in cART initiation or viral suppression. Viral rebound (22.2%) was more common in the black other [1.95 (1.37-2.77)], black African [1.85 (1.52-2.24)], black Caribbean [1.73 (1.28-2.33)], South Asian/other Asian [1.35 (0.90-2.03)] and other/mixed [1.09 (0.69-1.71)] groups than in white participants. CONCLUSION: Heterosexual people from black, Asian and minority ethnic (BAME) groups presented with lower CD4+ cell counts, spent less time engaged-in-care and were more likely to experience viral rebound than white people. Work to understand and address these differences is needed.
Authors: Linda Beer; Heather Bradley; Christine L Mattson; Christopher H Johnson; Brooke Hoots; Roy L Shouse Journal: J Acquir Immune Defic Syndr Date: 2016-12-01 Impact factor: 3.731
Authors: Tristan J Barber; Anna Maria Geretti; Jane Anderson; Achim Schwenk; Andrew N Phillips; Loveleen Bansi; Richard Gilson; Teresa Hill; John Walsh; Martin Fisher; Margaret Johnson; Frank Post; Philippa Easterbrook; Brian Gazzard; Adrian Palfreeman; Chloe Orkin; Clifford Leen; Mark Gompels; David Dunn; Valerie Delpech; Deenan Pillay; Caroline A Sabin Journal: Antivir Ther Date: 2011
Authors: Lisa S Burch; Colette J Smith; Jane Anderson; Lorraine Sherr; Alison J Rodger; Rebecca O'Connell; Anna-Maria Geretti; Richard Gilson; Martin Fisher; Jonathan Elford; Martin Jones; Simon Collins; Yusef Azad; Andrew N Phillips; Andrew Speakman; Margaret A Johnson; Fiona C Lampe Journal: Lancet Public Health Date: 2016-11