Race and psychiatric disorders influence the risk of highly active antiretroviral therapy (HAART) failure, according to a report by researchers at Walter Reed Army Naval Medical Center, Washington, DC.
Despite the high prevalence of HIV infection among African Americans, race as a variable affecting the efficacy of HAART has rarely been examined, the investigators note in the in the April 1st issue of the Journal of Acquired Immune Deficiency Syndromes.
Dr. Joshua D. Hartzell and colleagues investigated the impact of race and other factors on the ability of patients infected with HIV to reach and maintain viral suppression with HAART.
After 12 months of HAART, only 63% of African Americans reached viral suppression, the authors report, compared with 92% of whites. However, the difference was no longer significant after 24 months of treatment.
Women fared better than men, the results indicate, and officers did better than enlisted patients.
At 24 months (but not at 12 months), 23% more patients without a mental health diagnosis reached viral suppression than patients with a mental health diagnosis. Diagnoses included depression, adjustment disorder, anxiety disorder, and bipolar disorder.
In a multivariate analysis, viral suppression at 12 or 24 months was 8.5 times more likely in whites than in African Americans, 8.7 times more likely in patients without a mental health diagnosis, and 7 times more likely in women than in men. "This difference exists despite equal access to care for all beneficiaries," the investigators say.
"The current study augments the findings of other studies and suggests that discrepancies between races may not be simply secondary to access to care," the authors conclude. "Mental health continues to have a significant impact on HIV patients and potentially leads to virologic failure during HAART."
J Acquir Immune Defic Syndr 2007;44:411-416.
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