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Variations in Initial Prescription of Antiretroviral Therapy Among People With HIV Based on Race and Ethnicity

People entering HIV care in a large U.S. research consortium had consistent overall probabilities of treatment after 1 month, a study shows. Still, the use of integrase strand transfer inhibitor (INSTI)–containing antiretroviral therapy (ART) was less common among Black and Hispanic people in periods before the drugs became guideline-recommended initial therapy for most people with HIV.

The retrospective observational study included 42,841 adults at more than 200 clinical sites contributing to the North American AIDS Cohort Collaboration on Research and Design. The patients entered HIV care between the date of the first FDA approval of an INSTI (Oct. 2007) and Apr. 30, 2019. The main outcome measures were the probability of initial prescription of ART within 1 month of care entry and the probability of being prescribed INSTI-containing ART. 

“Of 41,263 patients with information on race and ethnicity, 19,378 (47%) as non-Hispanic Black, 6,798 (16%) identified as Hispanic, and 13,539 (33%) as non-Hispanic White; 36,394 patients (85%) were male, and the median age was 42 years (IQR, 30 to 51). From 2007-2015, when guidelines recommended treatment initiation based on CD4+ cell count, the probability of ART initiation within 1 month of care entry was 45% among White patients, 45% among Black patients (difference, 0% [95% CI, −1% to 1%]), and 51% among Hispanic patients (difference, 5% [95% CI, 4% to 7%]). From 2016-2019, when guidelines strongly recommended treating all patients regardless of CD4+ cell count, this probability increased to 66% among White patients, 68% among Black patients (difference, 2% [95% CI, −1% to 5%]), and 71% among Hispanic patients (difference, 5% [95% CI, 1% to 9%]). INSTIs were prescribed to 22% of White patients and only 17% of Black patients (difference, −5% [95% CI, −7% to −4%]) and 17% of Hispanic patients (difference, −5% [95% CI, −7% to −3%]) from 2009-2014, when INSTIs were approved as initial therapy but were not yet guideline recommended. Significant differences persisted for Black patients (difference, −6% [95% CI, −8% to −4%]) but not for Hispanic patients (difference, −1% [95% CI, −4% to 2%]) compared with White patients from 2014-2017, when INSTI-containing ART was a guideline-recommended option for initial therapy; differences by race and ethnicity were not statistically significant from 2017-2019, when INSTI-containing ART was the single recommended initial therapy for most people with HIV.”

Source: JAMA