Association Of Demographic Factors With CD4+ Cell Counts And Disease Progression In HIV-Infected Individuals

Abstract

Background: Highly active anti-retroviral therapy (HAART) has dramatically improved survival for HIV-infected individuals. Although HAART is considered the standard of care in the United States, differences in disease progression exist among ethnic groups of HIV-infected individuals. The Hawaii Sero-Positivity and Medical Management (HSPAMM) program is one of only a few national databases with a large number of HIV-infected individuals of Asian! Pacific Islander (API) ethnicity. In this study, we characterize the association of ethnicity with disease progression among HIV-infected individuals living in Hawaii. Methods: A retrospective study of HSPAMM participants from January 1989 to November 2002. Differences in survival among HIV-infected individuals who reported being on HAART were examined by ethnicity, income, and initial CD4+ cell counts using Kaplan Meier survival analysis and Cox proportional hazards analysis to adjust for covariates. Results: The study sample was based on 519 HIV-infected individuals. Caucasians represent the majority of the population with 315 (60.8%) participants. APIs made up the next largest ethnic category with 112 (21.6%) participants. There was a significant difference in initial CD4+ cell count and ethnicity (p=.038) among participants. Income was also highly significant when compared between ethnic groups (p=.001). In multivariate analyses, income and initial CD4+ cell count were significantly associated with faster disease progression. Significant differences among ethnic groups and disease progression were only found in association with low CD4+ cell counts (200 to 350 cells/mm3 ) and a lower income ($10,000 to 19,999 per capita). Discussion: Lower initial CD4+ cell counts and lower incomes were found to significantly increase the risk of faster disease progression and showed significant increases in the relative hazards of developing AIDS. Ethnicity was not found to be a strong predictor of disease progression, although differences in ethnicity were found to be highly associated with low initial CD4+ cell counts and lower incomes, which significantly increased the risk of faster disease progression.