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Am J Public Health. 2014 Nov;104(11):e135-41. doi: 10.2105/AJPH.2014.302227. Epub 2014 Sep 11.

The influence of race and comorbidity on the timely initiation of antiretroviral therapy among older persons living with HIV/AIDS.

Author information

Winston E. Abara is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Lerissa Smith and Harry J. Heiman are with the Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta. Shun Zhang and George Rust are with the National Center for Primary Care, Morehouse School of Medicine. Amanda J. Fairchild is with the Department of Psychology, University of South Carolina, Columbia.



We examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (≥ 50 years) people living with HIV/AIDS (PLWHA).


We conducted frequency and descriptive statistics analysis to characterize our sample, which we drew from 2005-2007 Medicaid claims data from 14 states. We employed univariate and multivariable Cox regression analyses to evaluate the relationship between race, comorbidity, and timely ART initiation (≤ 90 days post-HIV/AIDS diagnosis).


Approximately half of the participants did not commence ART promptly. After we adjusted for covariates, we found that older PLWHA who reported a comorbidity were 40% (95% confidence interval = 0.26, 0.61) as likely to commence ART promptly. We found no racial differences in the timely initiation of ART among older PLWHA.


Comorbidities affect timely ART initiation in older PLWHA. Older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to older PLWHA. Consistent Medicaid coverage helps ensure consistent access to HIV treatment and care and may eliminate racial disparities in timely ART initiation among older PLWHA.

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