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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Starley B. Shade, MPH1, Thomas F. Mitchell, MPH1, Scot Hammond1, Susan Jacobson, MD2, Ricardo Alvarez, MD3, and Donald I. Abrams1. (1) Positive Health Program, University of California, San Francisco, 3180 18th Street, Suite 201, San Francisco, CA 94110, (415-476-9554 ext 26, sshade@php.ucsf.edu, (2) East Bay AIDS Clinic, Alta Bates Summit Medical Center, 2850 Telegraph Avenue, Suite 110, Berkeley, CA 94705, (3) Mission Neighbor Health Center, 240 Shotwell Street, San Francisco, CA 94110
Objectives: To assess demographic differences in time from treatment failure to change in highly active antiretroviral therapy (HAART) in people with HIV.
Methods: Data were abstracted from patients’ medical records at seven clinics in the San Francisco Bay Area. Individuals who started a new HAART regimen (N=403) were included in these analyses. We assessed treatment failure using five criteria in the DHHS guidelines for the clinical care of people with HIV. Proportional hazard models were developed to assess demographic and clinical predictors of time from failure to treatment change.
Results: Overall, 274 patients (68%) experienced failure as defined by one or more criteria. Median time from failure to treatment change was 127 days.
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Category of failure |
Demographic Predictors of Treatment Change |
Hazard Ratio (95% C.I.) |
|
Viral load < 1 log10 decline after 8 weeks |
None |
--- --- |
|
Viral load > 50 after 6 months |
None |
--- --- |
|
Viral load > 5000 after previously undetectable viral load |
Age (10 yrs) Female Latino |
2.20 (1.06, 4.57) 5.29 (1.35, 20.77) 0.18 (0.04, 0.80) |
|
Viral Load 0.5 log10 greater than pre-treatment viral load |
Age (10 yrs) History of injection drug use Latino |
0.73 (0.56, 0.96) 3.16 (1.27, 7.90) 0.32 (0.14, 0.75) |
|
CD4 decline |
African American |
1.84 (1.02, 3.33) |
Conclusions: Demographic characteristics predicted time to treatment change under three of the five criteria for failure. These disparities may reflect differential acceptance among providers as to the appropriateness of these criteria. Additional research to test the clinical importance of these differences is warranted.
Learning Objectives:
Keywords: HIV/AIDS, Quality of Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.