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J Int AIDS Soc. 2016 Mar 18;19(1):20684. doi: 10.7448/IAS.19.1.20684. eCollection 2016.

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

Author information

1
Investigaciones Clínicas, Fundación Huésped, Buenos Aires, Argentina; carina.cesar@huesped.org.ar.
2
Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
3
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
4
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
5
Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
6
Department of Internal Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico.
7
Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
8
Fundación Arriarán and Facultad de Medicina, Universidad de Chile, Santiago, Chile.
9
Instituto Hondureño de Seguridad Social and Hospital Escuela Universitario, Tegucigalpa, Honduras.
10
Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico.
11
Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru.
12
Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
13
Division of General Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.
14
Division of Infectious Diseases, University of Washington, Seattle, WA, USA.
15
Infectious Diseases Section, Michael E. De Bakey VAMC, Baylor College of Medicine, Houston, TX, USA.
16
Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
17
Investigaciones Clínicas, Fundación Huésped, Buenos Aires, Argentina.

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.

KEYWORDS:

HIV; Latin America; North America; antiretroviral therapy; cohort studies; highly active; mortality

PMID:
26996992
PMCID:
PMC4800379
[Indexed for MEDLINE]
Free PMC Article

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