Virologic Response Differences Between African Americans and European Americans Initiating Highly Active Antiretroviral Therapy With Equal Access to Care

Weintrob, Amy; Grandits, Greg; Agan, Brian K.; Ganesan, Anuradha; Landrum, Michael L.; Crum-Cianflone, Nancy F.; Johnson, Erica; Ordóñez, Claudia E.; Wortmann, Glenn; Marconi, Vincent C.

doi:10.1097/qai.0b013e3181b98537

Cited by 64 publications

(57 citation statements)

References 26 publications

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“…Both minority race and pretreatment CD4 cell counts have been previously associated with an increased risk for virologic failure and poor clinical outcomes, including disease progression and death. 11,31,32,[34][35][36][37][38][39] In our study, we find that minority race and low pretreatment CD4 cell counts are also associated with an increased risk of the development of ARV resistance. The implementation of interventions targeting those individuals at greatest risk for the development of ARV resistance is important to maximizing the effectiveness and durability of initial ART regimens.…”

supporting

confidence: 51%

The Role of Toxicity-Related Regimen Changes in the Development of Antiretroviral Resistance

Nevin

Aban

et al. 2011

AIDS Research and Human Retroviruses

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In an effort to evaluate factors associated with the development of antiretroviral (ARV) resistance, we assessed the prevalence of toxicity-related regimen changes and modeled its association to the subsequent development of ARV resistance in a cohort of treatment-naive individuals initiating ARV therapy (ART). A retrospective analysis of patients initiating ART was conducted at the UAB 1917 Clinic from 1 January 2000 to 30 September 2007. Cox proportional hazards models were fit to identify factors associated with the development of resistance to ‡ 1 ARV drug class. Among 462 eligible participants, 14% (n = 64) developed ARV resistance. Individuals with ‡ 1 toxicity-related regimen change (HR = 3.94, 95% CI = 1.09-14.21), initiating ART containing ddI or d4T (4.12, 1.19-14.26), and from a minority race (2.91, 1.16-7.28) had increased risk of developing resistance. Achieving virologic suppression within 12 months of ART initiation (0.10, 0.05-0.20) and higher pretreatment CD4 count (0.85 per 50 cells/mm 3 , 0.75-0.96) were associated with decreased hazards of resistance. Changes in ART due to drug intolerance were associated with the subsequent development of ARV resistance. Understanding the role of ARV drug selection and other factors associated with the emergence of ARV resistance will help inform interventions to improve patient care and ensure long-term treatment success.

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supporting

confidence: 51%

The Role of Toxicity-Related Regimen Changes in the Development of Antiretroviral Resistance

Nevin

Aban

et al. 2011

AIDS Research and Human Retroviruses

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“…NHS participants were military beneficiaries (active duty, retirees, and dependents) who received care at one of seven U.S. geographic locations, as previously described (44). Medical care for beneficiaries, including antiretroviral medications, is free of charge.…”

Section: Methodsmentioning

confidence: 99%

Impact of Weight on Immune Cell Counts among HIV-Infected Persons

Crum-Cianflone

Roediger

Eberly

et al. 2011

Clin. Vaccine Immunol.

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Prior studies have shown that weight may impact immune cell counts. However, few data exist about the relationship of weight and immune cell counts among HIV-infected patients. We examined documented HIV seroconverters (mean window, 15.7 months) in a prospective U.S. Military HIV Natural History Study (1 January 1986 to 20 January 2010). We estimated the association of the time-updated body mass index (BMI) category with changes in immune cell counts from HIV diagnosis across time (mean follow-up of 5.1 years) using multiply adjusted longitudinal linear mixed-effects models. Of 1,097 HIV seroconverters, 448 (41%) were overweight and 93 (8%) were obese at HIV diagnosis. Immune cell counts at HIV diagnosis did not significantly differ by BMI category. In the longitudinal models for those diagnosed before the advent of the highly active antiretroviral therapy (HAART) era, mean postdiagnosis decreases in the white cell count, total lymphocyte count, CD4 count, CD4 percentage, and CD4/CD8 ratio were less as the BMI category increased (all with P values of <0.05). Among HIV seroconverters diagnosed in the HAART era, obese compared to normal-weight patients had significantly smaller increases in CD4 counts, CD4 percentages, and the CD4/CD8 ratio (all with P values of <0.05). Similar findings were also noted among underweight versus normal-weight patients. In conclusion, although BMI was not associated with immune cell levels at the time of HIV diagnosis, weight appears to affect immune cells counts over the course of infection. In the HAART era, being either underweight or obese was associated with smaller increases in several important immune cell levels, including the CD4/CD8 ratio.

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“…The NHS includes biannual study visits consisting of clinical interviews, physical examinations, and the collection of medical record data including antiretroviral use, CD4 counts, and HIV RNA levels. 6 Participants in the study are adult military beneficiaries, the majority of whom have narrowly defined seroconversion windows. HIV-infected adults who initiated ART (defined as ‡ 3 full-dose antiretroviral medications) during the period of 1/1/1996 to 12/ 31/2012 were identified (n = 2,981).…”

mentioning

confidence: 99%

Short Communication: HIV RNA Levels Predict AIDS-Defining and Non-AIDS-Defining Cancers After Antiretroviral Therapy Initiation Among HIV-Infected Adults

Crum-Cianflone

Wang

Ganesan

et al. 2015

AIDS Research and Human Retroviruses

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Whether poor virologic control is associated with incident cancers after initiation of combination antiretroviral therapy (ART) remains unclear. In a large cohort, time-updated HIV RNA levels ‡ 1,000 copies/ml predicted AIDS-defining cancers (ADCs), non-AIDS-defining cancers (NADCs), and skin cancers. Virologic control may be an important strategy in reducing cancer events among HIV-infected persons.

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Virologic Response Differences Between African Americans and European Americans Initiating Highly Active Antiretroviral Therapy With Equal Access to Care

Abstract: Despite similar durations of HIV infection and equal access to health care, AAs were significantly less likely to achieve viral suppression compared with EA.

Cited by 64 publications

References 26 publications

The Role of Toxicity-Related Regimen Changes in the Development of Antiretroviral Resistance

The Role of Toxicity-Related Regimen Changes in the Development of Antiretroviral Resistance

Impact of Weight on Immune Cell Counts among HIV-Infected Persons

Short Communication: HIV RNA Levels Predict AIDS-Defining and Non-AIDS-Defining Cancers After Antiretroviral Therapy Initiation Among HIV-Infected Adults

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