Life expectancy 6.3 years shorter for black MSM living with HIV

WASHINGTON, DC – The life expectancy of HIV-infected non-Hispanic black men who have sex with men (MSM) lags 6.3 years behind that of their white counterparts in the setting of HIV care. Standard HIV, according to new data from simulation modeling.

Lead author Katherine Rich, MPH, a student at Harvard Medical School in Boston, Massachusetts, presented the data Oct. 20 at IDWeek 2022.

“Substantial disparities in care exist between black and white MSM here in the United States,” she said. “The 2030 objectives of the EHE [Ending the HIV Epidemic in the US initiative] will not be achieved until HIV-related disparities are reduced. »

Using modeling, the team was able to measure both the gaps and the potential for interventions to fill those gaps.

  • The team found that improving engagement in care had the greatest benefit in closing the gap. Improving engagement and retention in care, they write, would lead to a gain of 1.4 years of life for black MSM and one year for white MSM.

  • Annual testing would add 0.6 years of life for black MSM and 0.3 years of life for white MSM compared to standard care.

  • By simulating viral suppression, the gain predicted by the model would be 1.1 years for black MSM; 0.3 for whites.

Additionally, a combination of annual testing, 95% care engagement, and 95% virologic suppression would add 3.4 years for black MSM (more than double the increase in years of life for any intervention) and 1.6 years for their white counterparts, the research suggests.

The researchers projected life expectancy from age 15 to 52.2 years for black MSM (or 67.2 years) and 58.5 years from age 15 for white MSM (or 73.5 years), a difference of 6.3 years.

Kathleen McManus, MD, assistant professor of medicine in infectious diseases and international health at the University of Virginia at Charlottesville, said Medscape Medical News the projected gap in life years should be a call to action. McManus did not participate in the study.

Life expectancy gap Alarming

“Alarmingly, with current usual HIV care, HIV-positive black MSM have 6.3 years less life expectancy than white MSM,” she said. “Black MSM with lower retention in care and a lower rate of viral suppression than white MSM demonstrates that there is a problem with our current delivery of health care to Black MSM.”

With qualitative and community-based research, she said, “we need to ask the Black MSM community what innovations in care they need, and then we need clinics and organizations to make the identified changes.” .

The researchers used the validated CEPAC (Cost-Effectiveness of AIDS Complications Prevention) HIV microsimulation model to project life expectancy. Using data from the US Centers for Disease Control and Prevention, they estimated that the average age at HIV infection was 26.8 for black MSM and 35 for MSM whites.

They estimated the proportion of time that MSM with an HIV diagnosis are kept in care at 75.2% for black MSM and 80.6% for white MSM. They calculated that the proportion of those achieving virologic suppression was 82% for black MSM and 91.2% for white MSM.

Lead author Emily P. Hyle, MD, an associate professor of medicine at Harvard and an infectious disease physician at Massachusetts General Hospital, said at a press conference ahead of the presentation that strategies for closing the gap will be different. depending on the regions.

“Our study highlights that if you can find effective interventions, the effect can be incredibly large. These are very large differences in years of life and life expectancies,” she said.

Rich gave an example of promising interventions, citing the work of study co-author Aima Ahonkhai, MD, MPH, assistant professor of medicine at Vanderbilt University in Nashville, Tennessee, who received federal funding to pursue research on whether raising awareness about preventive care in barbershops can improve prevention for black men living with HIV.

Rich noted that the modeling has limitations in that it focuses on health outcomes and does not simulate transmissions. The results also reflect national data and not local continua of HIV care which, she acknowledged, differ significantly.

McManus and the study authors reported no relevant financial relationships.

IDWeek 2022. Abstract #798. Presented October 20, 2022.

Marcia Frellick is a Chicago-based freelance journalist. She has written for the Chicago Tribune, Science News, and Nurse.com, and served as editor of the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter: @mfrellick

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