Effectiveness of highly-active antiretroviral therapy by race/ethnicity

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Abstract
To determine the effectiveness of HAART by race/ethnicity. Prospective multicenter cohort study. We studied 991 African–Americans and 911 European–Americans enrolled in the United States Military's Tri-Service AIDS Clinical Consortium Natural History Study who had dates of HIV seroconversion known within 5 years and followed between 1990 and 2002. We determined the rate of disease progression to AIDS and death for subjects in this cohort. Multivariable models evaluated race, pre-HAART (1990–1995) and HAART (1996–2002) eras, age, gender and military service. In the pre-HAART era, African–Americans had a statistically nonsignificant trend towards better outcomes: the relative hazards (RH) of AIDS and death for African–Americans compared to European–Americans were 0.85 [95% confidence interval (CI), 0.68–1.05] and 0.77 (95% CI, 0.55–1.08), respectively. In the HAART era, outcomes were similar by race: 1.17 (95% CI, 0.86–1.61) for AIDS and 1.11 (95% CI, 0.81–1.53) for death with overlapping Kaplan–Meier curves. Relative to the pre-HAART era, the adjusted RH of AIDS in the HAART era was 0.41 (95% CI, 0.31–0.54) and 0.30 (95% CI, 0.22–0.40) for African–American and European–American participants, respectively. Analogous RH for death were 0.55 (95% CI, 0.38–0.80) and 0.38 (95% CI, 0.27–0.54). The precipitous declines in AIDS and death in the HAART era were not statistically different by race. In a large multi-racial cohort with equal access to health care, HIV treatment outcomes by race/ethnicity were similar.