Abstract
ObjectiveLittle is known about the treatment outcomes of undocumented Hispanic immigrants with HIV infection. We sought to compare the treatment outcomes of undocumented and documented patients 12-months after entering HIV care.MethodsWe conducted a retrospective cohort study of antiretroviral-naive patients 18 years and older attending their first visit at Thomas Street Health Center in Houston, Texas, between 1/1/2003 and 6/30/2008. The study population of 1,620 HIV-infected adults included 186 undocumented Hispanic, 278 documented Hispanic, 986 Black, and 170 White patients. The main outcome measures were retention in care (quarter years with at least one completed HIV primary care provider visit) and HIV suppression (HIV RNA <400 copies/mL), both measured 12-months after entering HIV care.ResultsUndocumented Hispanic patients had lower median initial CD4 cell count (132 cells/mm3) than documented Hispanic patients (166 cells/mm3; P = 0.186), Black patients (226 cells/mm3; P<0.001), and White patients (264 cells/mm3; P = 0.001). However, once in care, undocumented Hispanic patients did as well or better than their documented counterparts. One year after entering HIV care, undocumented Hispanics achieved similar rates of retention in care and HIV suppression as documented Hispanic and White patients. Of note, black patients were significantly less likely to have optimal retention in care (adjusted odds ratio [aOR] 0.65, CI = 0.45–0.94) or achieve HIV suppression (aOR 0.32, CI = 0.17–0.61) than undocumented Hispanics.ConclusionsUndocumented Hispanic persons with HIV infection enter care with more advanced disease than documented persons, suggesting testing and/or linkage to care efforts for this difficult-to-reach population need intensification. Once diagnosed, however, undocumented Hispanics have outcomes as good as or better than other racial/ethnic groups. Safety net providers for undocumented immigrants are vital for maintaining individual and public health.
Highlights
HIV infection disproportionately affects Hispanics in the United States (US)
Patients excluded from analyses include 14 patients with age less than 18 years at intake, 3 patients with no baseline CD4 cell count results, and 18 Black and 3 White patients who had invalid social security number (SSN)
The undocumented group had a higher percentage of monolingual Spanish speakers than the documented Hispanic group (62.4% versus 30.7%)
Summary
While Hispanics represent about 16% of the total US population, they represent 20% of persons newly infected with HIV [1,2,3,4]. Hispanics are significantly more likely to enter HIV care with advanced disease [2,5,6,7,8]. Entry into HIV care late in the disease process results in worse clinical outcomes, including lower rates of viral suppression and worse survival [9,10,11,12]. Hispanics represent a heterogeneous population, diverse in country of origin and residency status. To better understand the barriers to timely HIV care and uptake of antiretroviral therapy, studies need to account for this diversity
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
