Uptake and outcome of combination antiretroviral therapy in men who have sex with men according to ethnic group: the UK CHIC Study.

TitleUptake and outcome of combination antiretroviral therapy in men who have sex with men according to ethnic group: the UK CHIC Study.
Publication TypeJournal Article
Year of Publication2012
Corporate AuthorsUnited Kingdom Collaborative HIV Cohort Study Group
JournalJ Acquir Immune Defic Syndr
Date Published2012 Apr 15
KeywordsAfrican Continental Ancestry Group, Antineoplastic Combined Chemotherapy Protocols, Asian Continental Ancestry Group, Cohort Studies, European Continental Ancestry Group, HIV Infections, Homosexuality, Male, Humans, Logistic Models, Lost to Follow-Up, Male, Patient Acceptance of Health Care, Risk Factors, United Kingdom

BACKGROUND: We investigated differences in retention in HIV care and uptake of combination antiretroviral therapy (cART) and treatment outcomes between different ethnic men who have sex with men (MSM) groups.METHODS: MSM subjects with known ethnicity and ≥1 day follow-up from 1996 to 2009 in the UK Collaborative HIV Cohort Study were included. Black and minority ethnic (BME) men were categorized as: black; Indian/Pakistani/Bangladeshi; other Asian/Oriental; and other/mixed. Logistic regression was used to identify factors associated with treatment initiation within the 6 months after each CD4 count. HIV viral load, CD4 counts, discontinuation/switch of a drug in the initial cART regimen, and development of a new AIDS event/death at 6 and 12 months were also analyzed.RESULTS: Of 16,406 MSM, 1818 (11.0%) were BME; 892 (49.1%) black, 139 (7.6%) Indian/Pakistani/Bangladeshi, 254 (13.9%) other Asian/Oriental, 532 (29.2%) other/mixed. The proportion of MSM with no follow-up after HIV diagnosis was higher among BME than white MSM (3.4% vs. 2.2%, P = 0.002). Permanent loss to follow-up was highest in the other/mixed and lowest in Indian/Pakistani/Bangladeshi groups (P = 0.02). Six thousand three hundred thirty-eight MSM initiated first cART from January 1, 2000, to January 1, 2009. In multivariable analyses, BME MSM were 18% less likely to initiate cART than white MSM with similar CD4 counts [adjusted odds ratio 0.82 (95% confidence interval: 0.74 to 0.91), P = 0.0001]. However, once on cART, there were no differences in virological, immunological, and clinical outcomes.CONCLUSIONS: This study demonstrates that despite BME MSM being a "minority within a minority" for those HIV infected, there are few ethnic disparities in access to and treatment outcomes in our setting.

Alternate JournalJ. Acquir. Immune Defic. Syndr.
PubMed ID22205437
Grant ListG0000199 / / Medical Research Council / United Kingdom
G0600337 / / Medical Research Council / United Kingdom