Dataset Information

Health outcomes among HIV-positive Latinos initiating antiretroviral therapy in North America versus Central and South America.

ABSTRACT:

Introduction

Latinos living with HIV in the Americas share a common ethnic and cultural heritage. In North America, Latinos have a relatively high rate of new HIV infections but lower rates of engagement at all stages of the care continuum, whereas in Latin America antiretroviral therapy (ART) services continue to expand to meet treatment needs. In this analysis, we compare HIV treatment outcomes between Latinos receiving ART in North America versus Latin America.

Methods

HIV-positive adults initiating ART at Caribbean, Central and South America Network for HIV (CCASAnet) sites were compared to Latino patients (based on country of origin or ethnic identity) starting treatment at North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) sites in the United States and Canada between 2000 and 2011. Cox proportional hazards models compared mortality, treatment interruption, antiretroviral regimen change, virologic failure and loss to follow-up between cohorts.

Results

The study included 8400 CCASAnet and 2786 NA-ACCORD patients initiating ART. CCASAnet patients were younger (median 35 vs. 37 years), more likely to be female (27% vs. 20%) and had lower nadir CD4 count (median 148 vs. 195 cells/µL, p<0.001 for all). In multivariable analyses, CCASAnet patients had a higher risk of mortality after ART initiation (adjusted hazard ratio (AHR) 1.61; 95% confidence interval (CI): 1.32 to 1.96), particularly during the first year, but a lower hazard of treatment interruption (AHR: 0.46; 95% CI: 0.42 to 0.50), change to second-line ART (AHR: 0.56; 95% CI: 0.51 to 0.62) and virologic failure (AHR: 0.52; 95% CI: 0.48 to 0.57).

Conclusions

HIV-positive Latinos initiating ART in Latin America have greater continuity of treatment but are at higher risk of death than Latinos in North America. Factors underlying these differences, such as HIV testing, linkage and access to care, warrant further investigation.

SUBMITTER: Cesar C

PROVIDER: S-EPMC4800379 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Publications

Health outcomes among HIV-positive Latinos initiating antiretroviral therapy in North America versus Central and South America.

Cesar Carina C Koethe John R JR Giganti Mark J MJ Rebeiro Peter P Althoff Keri N KN Napravnik Sonia S Mayor Angel A Grinsztejn Beatriz B Wolff Marcelo M Padgett Denis D Sierra-Madero Juan J Gotuzzo Eduardo E Sterling Timothy R TR Willig James J Levison Julie J Kitahata Mari M Rodriguez-Barradas Maria C MC Moore Richard D RD McGowan Catherine C Shepherd Bryan E BE Cahn Pedro P

Journal of the International AIDS Society 20160318 1

<h4>Introduction</h4>Latinos living with HIV in the Americas share a common ethnic and cultural heritage. In North America, Latinos have a relatively high rate of new HIV infections but lower rates of engagement at all stages of the care continuum, whereas in Latin America antiretroviral therapy (ART) services continue to expand to meet treatment needs. In this analysis, we compare HIV treatment outcomes between Latinos receiving ART in North America versus Latin America.<h4>Methods</h4>HIV-posi ...[more]

PMID: 26996992

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Dataset Information

Health outcomes among HIV-positive Latinos initiating antiretroviral therapy in North America versus Central and South America.

Introduction

Methods

Results

Conclusions

Publications

Health outcomes among HIV-positive Latinos initiating antiretroviral therapy in North America versus Central and South America.

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