Racial Differences in Virologic Failure Associated With Adherence and Quality of Life on Efavirenz-Containing Regimens for Initial HIV Therapy

Abstract

There was a greater effect of nonadherence on virologic failure in blacks given efavirenz-containing regimens than in whites. Self-reported adherence and QOL are independent predictors of virologic failure.

Effect of HIV‐1 Subtype on Virologic and Immunologic Response to Starting Highly Active Antiretroviral Therapy

“…Because most patients infected with subtype C strains were immigrants from sub-Saharan Africa, it can be proposed that cultural and socioeconomic factors play an important role in these patients' ability to maintain long-term adherence to treatment [34][35][36] and may also affect other determinants of treatment success, such as nutritional status and effective engagement with health care services. A role for socioeconomic determinants of adherence is suggested by the recent AIDS Clinical Trials Group A5095 trial, which detected a higher risk of virologic failure on efavirenz-containing regimens among black Americans relative to white Americans and found a significant correlation between race and adherence [37]. These findings indicate the need for targeted adherence support in these populations.…”

Longitudinal Relationships Between Antiretroviral Treatment Adherence and Discrimination Due to HIV-Serostatus, Race, and Sexual Orientation Among African–American Men with HIV

“…For example, research has found mean adherence rates of 67% of prescribed doses over 6 months [3]. Moreover, large racial/ethnic disparities exist: African–Americans with HIV have lower rates of antiretroviral adherence than do Whites with HIV [4-7]; African–Americans who are nonadherent experience worse disease outcomes (i.e., virological failure) compared to Whites with similar levels of nonadherence [8]; and African–Americans on antiretroviral treatment are less likely to achieve viral suppression than are Whites on antiretroviral treatment [9]. Thus, identifying reasons for treatment nonadherence among African–Americans in particular is critical for determining ways to improve their long-term health outcomes and ultimately to narrow disparities.…”

Poverty, Sex and HIV

“…Europeans are more likely to have this restriction factor than other population groups-an outcome which is speculated to be an impact of the Black Death (ibid: 102). A recent study found that African-Americans in the USA experience far greater virological failure when they are non-compliant with antiretroviral medication than their white counter-parts, and that this difference persists even after correcting for quality of life and socio-economic conditions (Schackman et al 2007). The strong possibility thus exists that Africans are more vulnerable to HIV and hence that this could also be accounting in part for the significance of the African dummy.…”