Gender, Race, and Geographic Disparities in HIV/AIDS Outcomes

Women, blacks, and people living in the southern U.S. had poorer HIV treatment outcomes than other groups, according to a study of more than 2000 seroconverters described in the February 15, 2011 Journal of Infectious Diseases. People from these disadvantaged populations were less likely to start antiretroviral therapy (ART) and more likely to experience HIV/AIDS-related events over 8 years of follow-up; those who started treatment, however, responded equally well after the first 6 months.

Research over the past 3 decades looking at the effects of demographic factors such as sex, race/ethnicity, and socioeconomic status on HIV and its treatment has produced conflicting results. Some studies have suggested that women and people of color respond less well to ART, for example, but others have shown that such differences are attributable to poorer access to care.

In the present study, Amie Meditz from the University of Colorado and colleagues sought to determine whether sex and race/ethnicity influence clinical outcomes following primary HIV infection. This analysis followed people who were identified as HIV positive within 1 year after infection, so it was not affected by the issue of early vs late diagnosis -- a confounding factor in many studies.

The analysis included 2277 participants in the Acute Infection and Early Disease Research Program, a multi-center observational cohort of individuals (mostly from North America and Australia) diagnosed with acute or recent HIV infection during the ART era. A limitation of the study was that only 5.4% of participants were women. The researchers classified participants as "white" or "non-white," with most of the "non-whites" being black. The majority (77%) of men were white, while the majority of women (55%) were non-white. Participants were followed for up to 8 years (average about 4.5 years).

Results

"Despite more favorable clinical parameters initially, female HIV-1-seroconverters had worse outcomes than did male seroconverters," the study authors concluded. "Elevated morbidity was associated with being non-white and residing in the southern United States."

While women, non-whites, and southerners were less likely to start ART, this did not fully account for differences in outcomes, they elaborated in their discussion, suggesting that these disparities could be attributable in part to socioeconomic factors including "access to health care, health behaviors, lifestyle, and environmental exposures." Given that differences in HIV outcomes between men and women are typically not observed in studies outside the U.S., they added that "sex differences in HIV-related morbidity observed in this study are not biologically based but are the result of socioeconomic conditions speci?c to the United States."

In an accompanying editorial, Carlos del Rio and Wendy Armstrong from Emory University cautioned that socioeconomic factors play an important role in determining HIV disease outcomes -- at both the individual and population levels -- and "although theoretically modifiable, they represent complex challenges that are beyond the traditional influence of public health."

Investigator affiliations: Departments of Medicine and Biostatistics & Informatics, University of Colorado Denver, Aurora, CO; Aaron Diamond AIDS Research Center, Rockefeller University, New York, NY; Department of Family and Preventive Medicine, University of California, San Diego, CA; Department of Medicine, University of California, San Francisco, CA; Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, CA; Department of Medicine, University of Washington, Seattle, WA; Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD; Department of Medicine and Microbiology/Immunology, University of Alabama, Birmingham, AL; Department of Medicine, McGill University Health Centre, Montreal, Canada; Department of Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada; National Centre for HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia; Partners AIDS Research Center, Boston, MA; Veterans Affairs San Diego Healthcare System, San Diego, CA.

1/25/11

References

AL Meditz, S MaWhinney, A Allshouse, and others. Sex, Race, and Geographic Region Influence Clinical Outcomes Following Primary HIV-1 Infection. Journal of Infectious Diseases 203(4): 442-451 (Free full text). February 15, 2011.

WS Armstrong and C del Rio. Gender, Race, and Geography: Do They Matter in Primary Human Immunodeficiency Virus Infection? Journal of Infectious Diseases 203(4): 437-438 (Free full text). February 15, 2011.

Other Source

Infectious Diseases Society of America. Sex, Race, and Geography Influence Health Outcomes of Those Identified Within a Year of HIV Infection. Press release. January 18, 2010.