Department of Preventive Medicine and Biometrics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
AIDS Res Ther. 2014 Jan 24;11(1):10. doi: 10.1186/1742-6405-11-10.
Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity.
Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 <200, AIDS event or severe symptoms; Group A), an indication to consider HAART (including CD4 <350; Group B) or electively started HAART (CD4 >350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count <200 cells/mm3. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR).
1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94% male, 46% African American, 40% Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk.
No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.
先前的研究表明，HAART 的启动可能因种族/民族而异。利用美国医疗保健系统，最大限度地减少医疗保健获取的混杂因素，我们分析了在高风险人群中，HAART 的启动时机和对卡氏肺孢子虫肺炎（PCP）的初级预防的适当启动是否因种族/民族而异。
1998 年至 2009 年参加美国军事艾滋病毒自然史研究的参与者，在 1998 年之前未开始 HAART，并且根据 DHHS 指南，有明确的 HAART 适应证（CD4 <200、艾滋病事件或严重症状；A 组）、考虑 HAART 的适应证（包括 CD4 <350；B 组）或选择性开始 HAART（CD4 >350；C 组），分析与 HAART 启动相关的因素。在二次分析中，还评估了参与者与在 CD4 计数 <200 个细胞/mm3 后四个月内开始初级 PCP 预防相关的因素。多因素逻辑回归用于比较开始治疗与延迟治疗的参与者；比较用比值比（OR）表示。
在 HAART 启动分析中，1262 名参与者接受了评估（A=208，B=637，C=479[62 名参与者同时评估了 A 组和 B 组]；94%为男性，46%为非裔美国人，40%为白人）。种族/民族与 A 组或 B 组的 HAART 启动无关。在 C 组中，非裔美国人的种族/民族与 HAART 启动的可能性较低相关（OR 0.49，p=0.04）。在有风险的 408 名参与者中，种族和民族也与原发性 PCP 预防的启动无关。
在有治疗适应证的人群中，HAART 或原发性 PCP 预防的启动没有观察到种族/民族差异。在以最高 CD4 细胞计数选择性开始 HAART 的人群中，非裔美国人的种族/民族与开始治疗的可能性降低有关。这表明免费医疗保健可以潜在地克服 HIV 护理中观察到的一些差异，但未测量的因素可能导致选择性护理决策的差异。
