Use of Highly Active Antiretroviral Therapy in a Cohort of HIV-Seropositive Women

Cook, Judith Α.; Cohen, Mardge H.; Grey, Dennis D.; Kirstein, Lynn M.; Burke, Jane; Anastos, Kathryn; Palacio, Herminia; Richardson, Jean L.; Wilson, Tracey E.; Young, Mary

doi:10.2105/ajph.92.1.82

Cited by 71 publications

(46 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Participants first reported use of combination antiretroviral therapy in early 1996; by 1998, over 50% reported use of combination therapy (15). A similar decline in mortality has been noted in other cohorts (16,17).…”

Section: Discussionmentioning

confidence: 63%

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Cohen

French

Benning

et al. 2002

The American Journal of Medicine

Self Cite

140

View full text Add to dashboard Cite

PURPOSE-To examine changes in the causes of death and mortality in women with human immunodeficiency virus (HIV) infection in the era of combination antiretroviral therapy.METHODS-Among women with, or at risk of, HIV infection, who were enrolled in a national study from 1994 to 1995, we used an algorithm that classified cause of death as due to acquired immunodeficiency syndrome (AIDS) or non-AIDS causes based on data from death certificates and the CD4 count. Poisson regression models were used to estimate death rates and to determine the risk factors for AIDS and non-AIDS deaths.RESULTS-Of 2059 HIV-infected women and 569 who were at risk of HIV infection, 468 (18%) had died by April 2000 (451 HIV-infected and 17 not infected). Causes of death were available for 428 participants (414 HIV-infected and 14 not infected). Among HIV-infected women, deaths were classified as AIDS (n = 294), non-AIDS (n = 91), or indeterminate (n = 29). The non-AIDS causes included liver failure (n = 19), drug overdose (n = 16), non-AIDS malignancies (n = 12), cardiac disease (n = 10), and murder, suicide, or accident (n = 10). Allcause mortality declined an average of 26% per year (P = 0.03) and AIDS-related mortality declined by 39% per year (P = 0.01), whereas non-AIDS-related mortality remained stable (10% average annual decrease, P = 0.73). Factors that were independently associated with non-AIDSrelated mortality included depression, history of injection drug use with hepatitis C infection, cigarette smoking, and age.CONCLUSION-A substantial minority (20%) of deaths among women with HIV was due to causes other than AIDS. Our data suggest that to decrease mortality further among HIV-infected women, attention must be paid to treatable conditions, such as hepatitis C, depression, and drug and tobacco use.With the advent of combination antiretroviral therapy, mortality for persons with acquired immunodeficiency disease syndrome (AIDS) in the United States has declined markedly (1-3). For women with AIDS, these declines have been delayed and smaller in magnitude than those seen in men (1,4), perhaps due to racial and sex differences in access to antiretroviral ©2002 by Excerpta Medica, Inc. Although most studies have not found sex-related differences in HIV disease progression (9,10), some have noted a worse prognosis for women, especially those who inject drugs (11,12). Causes of death were not examined in these studies. Assessing causes of death may clarify the effects of other medical problems on mortality of women with HIV infection.The purpose of this investigation was to evaluate cause-specific mortality of participants in the Women's Interagency HIV Study, the largest U.S. longitudinal study of women with HIV infection. We examined non-HIV-related causes of death, compared the changes in mortality between those who died of AIDS and those who died of non-AIDS causes, and compared risk factors for AIDS and non-AIDS mortality in the era of combination antiretroviral therapy. METHODS SampleThe Women's Interagency HIV Study...

show abstract

Section: Discussionmentioning

confidence: 63%

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Cohen

French

Benning

et al. 2002

The American Journal of Medicine

Self Cite

140

View full text Add to dashboard Cite

show abstract

“…The odds of ≥95% HAART adherence associated with no illicit drug use, white race, and older age in the WIHS were similar to those found by other investigators. 15,16 It will be particularly important for health care providers to discuss with HIV-infected mothers or caregivers, particularly mothers who have additional stressors such as living in poverty, how child care responsibilities may influence adherence. It may be necessary to establish support systems to alleviate the stress of child care responsibilities among these women based on the trends observed in this analysis.…”

Section: Discussionmentioning

confidence: 99%

“…For our analyses, participants were categorized dichotomously by whether they reported taking antiretroviral medications as prescribed ≥95% of the time. 16 Only visits at which participants reported using a HAART regimen at some point since their last visit were included in our analyses; all of the visits at which only no therapy, monotherapy, or non-HAART combination therapy were reported since their last visit were excluded.…”

Section: Outcome Variablementioning

confidence: 99%

Association Between Living With Children and Adherence to Highly Active Antiretroviral Therapy in the Women's Interagency HIV Study

et al. 2008

Self Cite

View full text Add to dashboard Cite

OBJECTIVE-The purpose of this work was to evaluate whether living with children adversely affects adherence to highly active antiretroviral therapy in HIV-infected women. PARTICIPANTS AND METHODS-We conducted a prospective cohort study between October 1998 and September 2005. The study outcome was ≥95% adherence to highly active antiretroviral therapy evaluated at 5832 semiannual visits among 1366 HIV-infected women in the Women's Interagency HIV Study. The primary exposure defined at the visit immediately before outcome ascertainment was the number of children ≤18 years of age reported living in the household. RESULTS-The percentage of women who reported ≥2 children in the household who also reported ≥95% adherence ranged from 68% to 75% compared with adherence when either 1 child or no children were reported. Each additional child reported living in the household was associated with a 6% decrease in the odds of ≥95% adherence.CONCLUSION-The impact of living with a child on the ability to take medications by HIVinfected women has not been examined thoroughly. Our data suggest that adherence to highly active antiretroviral therapy is inversely associated with the number of children living in the household. Keywords adherence; children; HAART; HIV What's Known on This SubjectAddress correspondence to Daniel J. Merenstein, MD, Georgetown University Medical Center, Department of Family Medicine, 417 Kober Cogan Hall, 3800 Reservoir Rd, NW, Washington, DC 20007. E-mail: djm23@georgetown.edu. The authors have indicated they have no financial relationships relevant to this article to disclose. Motherhood potentially places additional stresses on HIV-infected women, because mothers with HIV have been shown to have higher levels of depression, poorer family cohesion, less ability to perform daily functions, and more reliance on their children to perform daily responsibilities. NIH Public Access What This Study AddsWomen living with ≥2 children had a trend toward lower rates of adherence than women living without children. Furthermore, we found a consistently decreasing odds of >95% adherence to highly active antiretroviral therapy as the number of children in the household increased.Highly active antiretroviral therapy (HAART) has dramatically reduced both the morbidity and mortality among HIV-infected individuals. 1-4 The evolution of HIV treatment in the developed world has dictated a shift from acute care, in which physicians and patients are most concerned with preventing death or opportunistic infections, to care for a chronic disease with novel considerations. 5-7Optimal adherence to HAART is often difficult to achieve because of factors such as lack of social support, complexity of treatment regimens, and adverse drug effects. 8-14 Previous studies have also found that no illicit drug use, being white, higher education levels, presence of heath insurance, and having a regular primary care provider all positively influence adherence to HAART. 15-17 Unlike other chronic diseases in which lower adherence rat...

show abstract

“…Trends in HAART and non-HAART use in the WIHS cohort have been previously reported in detail (13,37). Briefly, monotherapy and non-HAART combination regimens were relatively common in the 1990s but declined over time such that these regimens have made up Ͻ5% of all regimens during the last 10 years.…”

Section: Methodsmentioning

confidence: 98%

Human Leukocyte Antigen Genotype and Risk of HIV Disease Progression before and after Initiation of Antiretroviral Therapy

Kuniholm

Gao

Xue

et al. 2011

J Virol

Self Cite

View full text Add to dashboard Cite

While the human leukocyte antigen (HLA) genotype has been associated with the rate of HIV disease progression in untreated patients, little is known regarding these relationships in patients using highly active antiretroviral therapy (HAART). The limited data reported to date identified few HLA-HIV disease associations in patients using HAART and even occasional associations that were opposite of those found in untreated patients. We conducted high-resolution HLA class I and II genotyping in a random sample (n ‫؍‬ 860) of HIV-seropositive women enrolled in a long-term cohort initiated in 1994. HLA-HIV disease associations before and after initiation of HAART were examined using multivariate analyses. In untreated HIV-seropositive patients, we observed many of the predicted associations, consistent with prior studies. For example, HLA-B*57 (␤ ‫؍‬ ؊0.7; 95% confidence interval [CI] ‫؍‬ ؊0.9 to ؊0.5; P ‫؍‬ 5 ؋ 10 ؊11 ) and Bw4 (␤ ‫؍‬ ؊0.2; 95% CI ‫؍‬ ؊0.4 to ؊0.1; P ‫؍‬ 0.009) were inversely associated with baseline HIV viral load, and B*57 was associated with a low risk of rapid CD4؉ decline (odds ratio [OR] ‫؍‬ 0.2; 95% CI ‫؍‬ 0.1 to 0.6; P ‫؍‬ 0.002). Conversely, in treated patients, the odds of a virological response to HAART were lower for B*57:01 (OR ‫؍‬ 0.2; 95% CI ‫؍‬ 0.0 to 0.9; P ‫؍‬ 0.03), and Bw4 (OR ‫؍‬ 0.4; 95% CI ‫؍‬ 0.1 to 1.0; P ‫؍‬ 0.04) was associated with low odds of an immunological response. The associations of HLA genotype with HIV disease are different and sometimes even opposite in treated and untreated patients.

show abstract

Use of Highly Active Antiretroviral Therapy in a Cohort of HIV-Seropositive Women

Abstract: After the penetration of HAART into this cohort, additional differences emerged between HAART users and nonusers. These findings can inform public health efforts to enhance women' access to the most effective types of therapy.

Cited by 71 publications

References 29 publications

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Association Between Living With Children and Adherence to Highly Active Antiretroviral Therapy in the Women's Interagency HIV Study

Human Leukocyte Antigen Genotype and Risk of HIV Disease Progression before and after Initiation of Antiretroviral Therapy

Contact Info

Product

Resources

About