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Disparities in Antiretroviral Treatment: A Comparison of Behaviorally HIV-Infected Youth and Adults in the HIV Research Network


Allison L. Agwu, MD, ScM, John A. Fleishman, PhD, P. Todd Korthuis, MD, MPH, et al

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Objectives: Increasing numbers of youth are becoming HIVinfected
and need highly active antiretroviral therapy (HAART). We
hypothesized that behaviorally HIV-infected youth (BIY) ages 18 to
24 years are less likely than adults (25 years or older) to receive
HAART and, once initiated, more likely to discontinue their first
HAART regimen.
Methods: Longitudinal analysis of treatment-naı¨ve patients (age 18
years or older) meeting criteria for HAART and followed at HIV
Research Network sites (2002–2008). Time from meeting criteria to
HAART initiation and duration on first regimen were assessed using
Cox proportional hazards regression.
Results: A total of 3127 (268 youth, 2859 adult) treatment-naı¨ve,
HIV-infected patients met criteria. BIY were more likely to be black
(66.8% vs 51.1%; P , 0.01) and less likely to identify injection drug
use HIV risk (1.1% vs 8.8%; P , 0.01) than adults 25 years of age
or older. Nearly 69% of BIY started HAART versus 79% of adults
(P , 0.001). Adults 25 to 29 years of age (adjusted hazards ratio
[AHR], 1.39; 95% confidence interval [CI], 1.12–1.73) and 50 years
of age or older (AHR, 1.24; 95% CI, 1.00–1.54), but not 30 to 49
years (AHR, 1.19; 95% CI, 0.99–1.44) were more likely to initiate
HAART than BIY. Attending four or more HIV provider visits within
1 year of meeting criteria was associated with HAART initiation
(AHR, 1.91; 1.70–2.14). CD4 200 to 350 versus less than 200 cells/
mm3 (AHR, 0.57; 95% CI, 0.52–0.63), and injection drug use (AHR,
0.80; 95% CI, 0.69–0.92) were associated with a lower likelihood of
HAART initiation. There were no age-related differences in duration
of the first regimen.
Conclusion: BIY are less likely to start HAART when meeting
treatment criteria. Addressing factors associated with this disparity is
critical to improving care for youth.




Behavior, Adolescent


Created at 8/19/2011 1:07 PM by Davis, Gregory P
Last modified at 8/19/2011 1:07 PM by Davis, Gregory P