Sex, Race, and Geographic Region Influence Clinical Outcomes Following Primary HIV-1 Infection

Meditz, Amie L.; MaWhinney, Samantha; Allshouse, Amanda A.; Feser, William J.; Markowitz, Martin; Little, Susan J.; Hecht, Richard D.; Daar, Eric S.; Collier, Ann C.; Margolick, Joseph B.; Kilby, J. Michael; Routy, Jean Pierre; Conway, Brian; Kaldor, John; Levy, Jay A.; Schooley, Robert T.; Cooper, David A.; Altfeld, Marcus; Richman, Douglas D.; Connick, Elizabeth

doi:10.1093/infdis/jiq085

Cited by 151 publications

(148 citation statements)

References 36 publications

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“…In our cohort, racial preponderance among AHI cases has evolved; approximately half (50%) were white in 2003, with an increase in African-Americans from 56% in 2007 to 67% of the total cohort in 2010. These characteristics distinguish the present cohort from other AHI studies, where AfricanAmericans are often underrepresented (constituting only 7-18% of the population 1,18,19 ), despite the fact that this racial group accounts for 44% of all new HIV-1 infections. 20 Recent incidence data indicate that young black MSM have become the driver of new HIV-1 infections nationwide.…”

Section: Discussionmentioning

confidence: 67%

Acute HIV-1 Infection in the Southeastern United States: A Cohort Study

McKellar

Cope²,

McGee

et al. 2013

AIDS Research and Human Retroviruses

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In 1998 a collaboration between Duke University and the University of North Carolina, Chapel Hill (UNC) was founded to enhance identification of persons with acute HIV-1 infection (AHI). The Duke-UNC AHI Research Consortium Cohort consists of patients ‡ 18 years old with a positive nucleic acid amplification test (NAAT) and either a negative enzyme immunoassay (EIA) test or a positive EIA with a negative/indeterminate Western blot. Patients were referred to the cohort from acute care settings and state-funded HIV testing sites that use NAAT testing on pooled HIV-1 antibody-negative samples. Between 1998 and 2010, 155 patients with AHI were enrolled: 81 (52%) African-Americans, 63 (41%) white, non-Hispanics, 137 (88%) males, 108 (70%) men who have sex with men (MSM), and 18 (12%) females. The median age was 27 years . Most (n = 138/155) reported symptoms with a median duration of 17.5 days. The median nadir CD4 count was 408 cells/mm 3 (IQR 289-563); the median observed peak HIV-1 level was 726,859 copies/ml (IQR 167,565,728). The emergency department was the most frequent site of initial presentation (n = 55/152; 3 missing data). AHI diagnosis was made at time of first contact in 62/137 (45%; 18 missing data) patients. This prospectively enrolled cohort is the largest group of patients with AHI reported from the Southeastern United States. The demographics reflect the epidemic of this geographic area with a high proportion of African-Americans, including young black MSM. Highlighting the challenges of diagnosing AHI, less than half of the patients were diagnosed at the first healthcare visit. Women made up a small proportion despite increasing numbers in our clinics.

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Section: Discussionmentioning

confidence: 67%

Acute HIV-1 Infection in the Southeastern United States: A Cohort Study

McKellar

Cope²,

McGee

et al. 2013

AIDS Research and Human Retroviruses

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“…[3][4][5] Gains in health, longevity, and reductions in acute care usage, however, have not been uniform across all population groups in the US. Among HIV-infected individuals, women, 6-9 injection drug users, 7,8,10 and racial/ethnic minorities 8,11,12 account disproportionately for morbidity and suboptimal health-care utilization patterns. Socioeconomic marginalization, in the form of unmet subsistence needs, may drive the acute care usage seen in these subpopulations.…”

Section: Introductionmentioning

confidence: 99%

Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco

et al. 2012

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“…In the US, women on cART are more likely to fail treatment compared to men on the same medications [7,13,[15][16][17][18]. Survival and infection rates of PLWH also differ significantly among ethnicities in the US, with African Americans bearing the majority of deaths and new infections [7,11,15,17].…”

Section: Introductionmentioning

confidence: 99%

“…Survival and infection rates of PLWH also differ significantly among ethnicities in the US, with African Americans bearing the majority of deaths and new infections [7,11,15,17]. These differences seem to be related to adverse psychosocial factors more prevalent within specific demographic groups, compared to the general population [11,16,17,19,20]. Psychiatric disorders, particularly depression and substance abuse, are strongly associated with poorer quality of life and response to cART among PLWH [9,11,15,18,[21][22][23].…”

Section: Introductionmentioning

confidence: 99%

The Detrimental Effect of Adversity on HIV Outcomes in the Era of Combined Anti-Retroviral Therapy

Cancedda¹,

Eddens²,

Adebona³

et al. 2012

WJA

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Socially disadvantaged individuals with HIV experience unacceptably high rates of AIDS and death. The authors developed an adversity index to quantify the impact of demographic and psychosocial factors on HIV care. This retrospective cohort study included 431 participants with HIV on combined antiretroviral therapy between 2000 and 2005. Poor outcome was defined as progression to AIDS, death, virologic failure, or CD4 < 200 cells/µl at six months. The index utilized eight demographic and psychosocial variables independently associated with poor outcome. Exposure to higher numbers of variables in the adversity index significantly increased the rates of poor outcome from 14% (exposure to no variables) to 100% (exposure to seven variables). The odds of poor outcome decreased but remained significant after adjusting for adherence-defining variables, indicating a possible mediating effect of poor adherence. Durably effective therapeutic strategies must include addressing adverse demographic and psychosocial factors affecting people living with HIV.

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Sex, Race, and Geographic Region Influence Clinical Outcomes Following Primary HIV-1 Infection

Abstract: Despite more favorable clinical parameters initially, female HIV-1-seroconverters had worse outcomes than did male seroconverters. Elevated morbidity was associated with being nonwhite and residing in the southern United States.

Cited by 151 publications

References 36 publications

Acute HIV-1 Infection in the Southeastern United States: A Cohort Study

Acute HIV-1 Infection in the Southeastern United States: A Cohort Study

Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco

The Detrimental Effect of Adversity on HIV Outcomes in the Era of Combined Anti-Retroviral Therapy

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