Black women with HIV had the highest risk of premature death, according to a 21-year study.
In a retrospective analysis of over 6,500 HIV-positive patients, black women with HIV had an age-adjusted potential years of life lost (aYPLL) per 1,000 person-years of 592.5 (95 CI % 588.4-596.6) compared to HIV-positive white men with an aYPLL of 308.6 (95% CI 308-309.2), reported Rachael Pellegrino, MD, MPH, of Vanderbilt University Medical Center (VUMC) in Nashville, during the virtual IDWeek.
Black women with HIV were also younger at diagnosis than white women and black men (592.5 vs. 411.5 vs. 470.7 aYPLL, respectively), she said.
And “Dead women lost an average of 5.5 more years of life than MSM [men who have sex with men] people with HIV, âPellegrino said. âBlack adults who died lost about 9 months more life than white people. “
Pellegrino and colleagues assessed trends in mortality from January 1998 to December 2018 for people living with HIV using person-time from entry to clinic through date of death, and found that Mortality rates declined dramatically throughout the duration of the study, the most recent years (2014 to 2018) linked to a 73% reduced risk of death for all HIV-infected patients compared to the start of the study (1998 to 2003).
âHIV is no longer a death sentence for millions of people living with the disease,â Pellegrino said in a press release. “While these advances are cause for celebration, we cannot ignore the persistent disparities in outcomes that make HIV-positive women and black women, in particular, more likely to die or die prematurely.”
With the emergence of antiretroviral therapy and pre-exposure prophylaxis (PrEP), HIV death rates have declined over the years, but premature deaths from all causes due to disparities in risk factors, gender and race always prove difficult. A recent study found gaps in PrEP care associated with minorities and people with drug addiction.
The primary outcome of the present study was the mortality of HIV-infected patients as measured by YPLL with multivariate regression models adjusted for demographic and clinical factors. The data provided annual estimates, quantifying the AVP before age 75 per 100,000 people.
“YPLL is a useful metric for examining persistent gaps in longevity and premature mortality in PWH [people with HIV]”, according to the authors.
YPLL “is a measure that has not been widely used in HIV research,” said co-author Jessica L. Castilho, MD, MPH, also of VUMC, in the release. “We tend to focus on death as an outcome, but looking at the potential years of life lost gives us a different perspective on the impact of health disparities.”
Most of the study participants were men (78%), and about half were white (51%), while 40% were black. The median age at diagnosis of HIV was almost 32 years. MSM and transgender women accounted for 57% of patients. Hepatitis C virus (HCV) coinfection was present in 13%. Just over 14% died during the study.
Analysis models adjusted for covariates, such as age, HIV or HCV status, year, and injection drug use, demonstrated that being female (adjusted incidence rate ratio 1, 32, 95% CI 1.13-1.55 vs. males) – but not non-Hispanic Black race (aIRR 1.02, 95% CI 0.88-1.17 vs. non-Hispanic white) – was linked to increased mortality.
And Pellegrino’s group found that blacks, Hispanics, women, and older people were more likely to experience delays in diagnosing HIV than whites, while blacks were more likely to experience discontinuity of care. .
The lowest prevalence of sustained viral suppression was observed in blacks aged 13 to 29 years.
Limitations of the study included the fact that it was performed in a single center, the relatively small sample size, and the lack of data on the definitive causation of mortality.
However, âLooking at YLL, and not just death rates among people living with HIV, [the study] highlights that racial and gender inequalities continue to negatively impact ‘at-risk’ communities, “commented Antonio Urbina, MD, of the Mount Sinai Institute of Advanced Medicine in New York City, who did not attend under consideration. âUnpack the reasons as this is essential in helping us address these lingering gaps. “
IDWeek is the annual joint meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the Pediatric Infectious Diseases Society, the HIV Medicine Association, and the Society of Infectious Diseases Pharmacists.
The study was funded by the NIH.
Pellegrino has not disclosed any relationship with the industry. A co-author has revealed relationships with Gilead.