1255. Comparison in AIDS-Related Mortality Between African Americans and Whites with Human Immunodeficiency Virus During the HAART Era

Abstract

BackgroundHigher death rates have been reported in African American (AA) compared with non-Hispanic whites with HIV infection. However, there are no published studies of attributable mortality by racial and ethnic groups. We evaluated differences in attributable mortality between AA and whites.MethodsWe conducted a retrospective review of all persons with HIV infection who received care at the University of Cincinnati Medical Center whose deaths were between 1996 and 2017. We abstracted chart data using a standard data tool and identified all deaths reported to the social security national database. Probable cause of death was assigned using the EuroSida CoDe methodology. Primary endpoint was to compare AIDS vs. non-AIDS-related deaths between AA and whites.ResultsInitial analysis of 588 deaths are reported through 2007 (44% AA and 53% white). The median age at the time of HIV diagnosis was 37 years for AA patients and 36 years for white patients, while median age at the time of death was 43 years for AA and 42 years for whites (P = ns). 16.9% of AA were women, 2.6% were transgender; 10.3% of whites were women and 1% were transgender (P < 0.02). Risk factors for HIV acquisition included: MSM, 61.3% of whites vs. 46.0% AA; heterosexual contact, 11.7% of whites vs. 13.4% for AA; and injection drug use 16.9% white vs. 18.3% AA (P < 0.0001). African Americans had both lower median CD4 counts at the time of diagnosis and within 3–6 months prior to death (167 and 68 cells/mm3, respectively) as compared with whites (214 and 103 cells/mm3, respectively) (P < 0.0001 for both). There was no statistical significance of having AIDS at entry into the practice between AA and whites (P = 0.79). AIDS-related deaths accounted for a larger percentage of overall deaths within white patients (51%) compared with AA patients (40%) (P = 0.03).ConclusionOur data show that while a greater percent of AIDS-related deaths were found in whites vs. AA in the early HAART era, AA patients typically have lower CD4 counts at the time of diagnosis and within 3–6 months prior to death. Future analyses will examine specific attributable mortality, HIV viremia and changes in causes of death over later HAART era. Understanding factors associated with mortality may inform care models to prevent or delay future deaths.Disclosures All authors: No reported disclosures.