The relationships between age, gender, and race and rate of immune recovery and life expectancy among patients living with HIV
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Despite medical advancement transforming HIV disease from a death sentence to a chronic illness, not all patients living with HIV (PLWH) experience the best health outcomes. The purpose of this study was to identify disparities (age, gender, and ethnicity) in health outcomes among patients living with HIV who reside in Texas. HIV surveillance data from the Texas Department of State Health Services was used to identify patients diagnosed with HIV between 1996 and 2013. This cohort was divided into 4 subcohorts according to year of HIV diagnosis; 1996-1997, 1998-2006, 2007-2010, and 2011-2013. The primary outcomes were rate of immune recovery, AIDS diagnosis, and death. Hierarchical linear models and survival analyses were used to assess the relationships between age, gender, and ethnicity and rate of immune recovery and AIDS diagnosis and death. A total of 70,996 patients were included in the study; 7,206, 36,286, 15,628, and 11,876 in the 1996-1997, 1998-2006, 2007-2010, and 2011-2013 subcohorts respectively. The results showed that age, gender, and ethnicity were not statistically associated with rate of immune recovery (p>0.01) but tended towards lower rate of immune recovery with increasing age and in males and Hispanics. Age was associated with clinical progression to AIDS and death (p<0.01) in all 4 subcohorts. Male gender was associated with clinical progression to AIDS in all subcohorts except the 2011-2013 subcohort but there was no relationship between gender and death in the 4 subcohorts. Compared to Hispanics, the risk of an AIDS diagnosis was lower in Blacks across all 4 subcohorts. After controlling for covariates, the relationship was lost in the 1996-1997 and 2011-2013 subcohorts. There was no clear difference in the risk of an AIDS diagnosis between Blacks and Whites. Compared to Whites and Hispanics, Blacks had higher risk of death in the 1996-1997 and 1998-2006 subcohorts. However, there was no relationship between ethnicity and death in the 2007-2010 and 2011-2013 subcohorts after controlling for covariates. In conclusion, the results of the survival analyses suggests some clinical relevance of differential rates of immune recovery, which presents an opportunity for early intervention before long-term outcomes like AIDS diagnosis and death occur.