Black Women with HIV Face Higher Early Death Risk

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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 patients with HIV, black women with HIV had an age-adjusted years of potential life lost (aYPLL) per 1,000 person-years of 592.5 (95% CI 588.4-596.6) versus white men with HIV with an aYPLL of 308.6 (95% CI 308-309.2), reported Rachael Pellegrino, MD, MPH, of Vanderbilt University Medical Center (VUMC) in Nashville, at the virtual IDWeek.

Black females with HIV also were younger at diagnosis versus white females and Black males (592.5 vs 411.5 vs 470.7 aYPLL, respectively), she stated.

And “Women who died had an average of 5.5 more years of life lost than MSM [men who have sex with men] individuals with HIV,” said Pellegrino. “Black adults who died had approximately 9 months more of life lost when compared to white individuals.”

Pellegrino and colleagues assessed mortality trends from January 1998 to December 2018 for people with HIV using person-time from clinic entry to date of death, and found that mortality rates significantly declined throughout the study duration, with the most recent years (2014 to 2018) tied to a 73% reduced mortality risk for all HIV patients versus early on in the study (1998 to 2003).

“HIV is no longer a death sentence for millions living with the disease,” Pellegrino said in a press release. “While this progress is cause for celebration, we cannot ignore persistent disparities in outcomes that make women with HIV and Black women, in particular, more likely to die or die prematurely.”

With the emergence of antiretroviral therapy and preexposure prophylaxis (PrEP), HIV mortality rates have declined over the years, but premature all-cause deaths due to disparities in risk factors, sex, and race still prove challenging. A recent study found gaps in PrEP care associated with minorities and those suffering from substance abuse.

The current study’s primary outcome was HIV patient mortality as measured by YPLL with multivariable regression models adjusting for demographic and clinical factors. Data provided annual estimates, quantifying the YPLL prior to age 75 for every 100,000 people.

“YPLL is a useful measure for examining persistent gaps in longevity and premature mortality among PWH [people with HIV],” according to the authors.

YPLL “is a measure that hasn’t been widely used in HIV research,” explained co-author Jessica L. Castilho, MD, MPH, also of VUMC, in the release. “We tend to focus on death as the outcome but looking at years of potential life lost gives us a different perspective on the impact of health disparities.”

Most of the study participants were male (78%), and about half were white (51%), while 40% were Black. Median age at HIV diagnosis was nearly 32. MSM and transgender women accounted for 57% of the patients. Hepatitis C virus (HCV) coinfection was present among 13%. A little 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 of non-Hispanic Black race (aIRR 1.02, 95% CI 0.88-1.17 vs non-Hispanic white) — was linked with increased mortality.

And Pellegrino’s group found that Black, Hispanic, female, and older individuals were more likely to experience delays in HIV diagnoses than whites, while Blacks were more likely to experience a discontinuity of care.

The lowest prevalence of maintained viral suppression was seen among Black individuals, ages 13 to 29.

Study limitations included the fact that it was done at a single center, the relatively small sample size, and the lack of data on definitive mortality causation.

However, by “Looking at YPLL, and not just mortality rates in persons with HIV, [the study] shines the light that racial and gender inequalities continue to negatively impact ‘at-risk’ communities,” commented Antonio Urbina, MD, of Mount Sinai Institute of Advanced Medicine in New York City, who was not involved in the study. “Unpacking the reasons for this are key to helping us address these persistent gaps.”

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    Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. She is based in Chicago.

Disclosures

IDWeek is the annual joint meeting of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pediatric Infectious Diseases Society, HIV Medicine Association, and Society of Infectious Diseases Pharmacists.

The study was funded by the NIH.

Pellegrino disclosed no relationships with industry. A coauthor disclosed relationships with Gilead.

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