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
Volume59
Issue5
Pagination523-9
Date Published2012 Apr 15
ISSN1944-7884
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
Abstract

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.

DOI10.1097/QAI.0b013e318245c9ca
Alternate JournalJ. Acquir. Immune Defic. Syndr.
PubMed ID22205437
Grant ListG0000199 / / Medical Research Council / United Kingdom
G0600337 / / Medical Research Council / United Kingdom