By
Liz Highleyman
Research
has shown that HIV patients who take their antiretroviral
drugs as prescribed all or most of the time are more
likely to achieve good treatment outcomes than those who
do so with less regularity.
Studies
to date have provided conflicting evidence about whether
people of various racial/ethnic groups respond
equally to ART. Some research suggests that apparent
differences in response may be attributable to socioeconomic
status and lifestyle factors, and these may influence adherence.
In
the present study, Debora Lee Oh from the University of
California at Los Angeles and colleagues looked levels of
ART adherence in white, Hispanic, and black men, and assessed
specific factors associated with adherence in each group.
The analysis included data from 1102 men enrolled in the
Multicenter AIDS Cohort Study (MACS) followed between April
2002 and October 2006.
Self-reported
100% adherence was defined as taking all doses and pills
over the previous 4-day period, not typically skipping any
medications, and always following the prescribed medication
schedule.
Results
 |
Overall,
rates of complete adherence were relatively low (due
in part to the strict definition of 100% adherence).
|
|
After
controlling for potential confounding factors, Hispanic
patients were 2.16 times more likely than whites to
not report 100% adherence. |
|
Black
patients were 1.37 times more likely than whites to
not report complete adherence. |
|
Hispanic
patients with ethnic backgrounds from Central and South
America and the Caribbean had lower rates of adherence
than those from Europe. |
|
Black
patients with ethnic backgrounds from the Caribbean
had lower adherence rates than those from other regions.
|
"We conclude that adherence is multifactorial and varies
significantly by race and ethnicity," the study authors
wrote. "We found that blacks and Hispanics are more
likely to be non-adherent and that individuals from Central
and South America and the Caribbean are especially at risk
for non-adherence. Future adherence research and interventions
should focus not solely on racial groups but also the ethnic
differences within groups."
"Current
usage of racial categories masks rich differences within
groups," the researchers elaborated in their discussion
of the results. "Ethnicity is frequently used interchangeably
with race, although there are subtle differences that make
them distinct concepts. Race is often socially imposed and
dependent on one's biology. Ethnicity, however, is more
closely related to culture and with which group an individual
identifies. This distinction is important to note as race
and ethnicity may affect health behaviors in different ways."
Department
of Epidemiology, School of Public Health, University of
California, Los Angeles, CA; Department of Infectious Diseases
and Microbiology, University of Pittsburgh, Graduate School
of Public Health, Pittsburgh PA; Division of Endocrinology
and Metabolism, Johns Hopkins University, Baltimore MD;
Division of Infectious Diseases, CORE Center, Cook County
Health and Hospitals System. Chicago, IL.
10/20/09
Reference
D
Oh, F Sarafian, A Silvestre, and others. Evaluation of Adherence
and Factors Affecting Adherence to Combination Antiretroviral
Therapy Among White, Hispanic, and Black Men in the MACS
Cohort. Journal of Acquired Immune Deficiency Syndromes.
June 10, 2009 (epub ahead of print). (Abstract).
