Survival after diagnosis of AIDS, United States

Abstract

Purpose Some studies suggest racial/ethnic minorities and women have less access to highly active antiretroviral therapy (HAART), which can slow progression from AIDS diagnosis to death. We examined differences in survival among demographic subgroups of persons (aged ≥13 years) diagnosed with AIDS after HAART became widely available (1996). Methods AIDS cases diagnosed during 1996–2001 in 50 states and the District of Columbia were followed up through 2002. Three-year relative survival proportions were calculated by race/ethnicity, sex, 10-year age groups, transmission category, AIDS diagnosis year, and CD4 count at or within 6 month after AIDS diagnosis. Relative survival adjusts for normal expected survival in the general population, which was obtained from life tables calculated using U.S. death certificate information. We applied a generalized linear model with Poisson distribution to obtain relative excess hazards for race/ethnicity and sex while adjusting for the other covariates. Results Three-year relative survival was significantly lower for non-Hispanic black (80.2%; 95% CI 80.0, 80.5), American Indian (80.9%; 78.0, 83.4), and Hispanic persons (83.2%; 82.8, 83.5) compared with whites (84.9%; 84.6, 85.1). Survival among Asians (84.9%; 83.2, 86.4) was similar to whites. Survival was somewhat lower for women (81.3%; 81.0, 81.6) than men (82.7%; 82.6, 82.9). Survival was also lower for all transmission categories compared with men who have sex with men, those diagnosed at older ages compared with younger persons, and those diagnosed at lower CD4 counts compared with those with higher CD4 counts. Survival improved with later years of AIDS diagnosis (1996–1999). Multivariate relative survival models confirmed the poorer survival for blacks, American Indians, women, and older persons after adjustment for other covariates. conclusions Among persons with AIDS, certain minority groups, women, and older persons have poorer 3-year survival than their counterparts. These groups may lack adequate access to treatment to slow disease progression.