Disparities In Initiation Of Haart And In Virologic Suppression Among Patients In The Hiv Outpatient Study (Hops), 2000-2010

Improving and reducing disparities in time to HAART initiation and virologic suppression (VS) can assist in reducing U.S. human immunodeficiency virus (HIV) incidence. Using data from ARV-naïve patients who enrolled in HOPS in 2000-2010 ≤6 months of HIV diagnosis and attended ≥2 visits, we assessed temporal trends and correlates of initiating HAART and achieving VS (<500 copies/mL) via Kaplan-Meier curves and Cox proportional hazards models. Among 1,112 patients included in our analysis, patients were less likely to start HAART and achieve VS ≤1 year of diagnosis if they were diagnosed in 2000-2003 vs 2008-2010 (for HAART initiation: 62.5% vs 78.2%, P<0.01; for VS: 53.4% vs 70.7%, P<0.01, respectively), age <30 vs ≥40 years (57.6% vs 71.8%, P = 0.01 and 50.6% vs 66.3%, P<0.01), or non-Hispanic blacks (NHB) compared with non-Hispanic whites (NHW) (63.4% vs 67.1%, P = 0.01 and 56.2% vs 62.4%, P = 0.01). In multivariable models, patients were more likely to initiate HAART sooner if diagnosed after 2000-2003 (adjusted hazard ratios [95% confidence intervals] for 2004-2007 and 2008-2010: 1.2 [1.0-1.3] and 1.6 [1.3-1.9]) but were less likely to start if age <30 vs ≥40 years (0.8 [0.7-0.9]), NHB vs NHW (0.7 [0.6-0.9]) and female (0.8 [0.7-1.0]). Similar findings were observed for achieving VS after diagnosis with the exception of sex. In an analysis of outcomes after HAART initiation, further adjusted for CD4 count and plasma HIV RNA viral load (VL) at HAART initiation, NHB compared with NHW were less likely to achieve VS after HAART initiation (0.7 [0.6-0.9]), while age and gender were no longer significant explanatory factors. During 2000-2010, starting HAART and achieving VS ≤12 months became increasingly more common. Adjusting for CD4 and VL at start of HAART, only NHB had decreased likelihood of achieving VS after HAART initiation.