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Health outcomes among HIV-positive Latinos initiating antiretroviral therapy in North America versus Central and South America

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dc.contributor.author Cesar, C.
dc.contributor.author Koethe, J.R.
dc.contributor.author Giganti, M.J.
dc.contributor.author Rebeiro, P.
dc.contributor.author Althoff, K.N.
dc.contributor.author Napravnik, S.
dc.contributor.author Mayor, A.
dc.contributor.author Grinsztejn, B.
dc.contributor.author Wolff, M.
dc.contributor.author Padgett, D.
dc.contributor.author Sierra Madero, J.
dc.contributor.author Gotuzzo, E.
dc.contributor.author Sterling, T.R.
dc.contributor.author Willig, J.
dc.contributor.author Levison, J.
dc.contributor.author Kitahata, M.
dc.contributor.author Rodriguez-Barradas, M.C.
dc.contributor.author Moore, R.D.
dc.contributor.author McGowan, C.
dc.contributor.author Shepherd, B.E.
dc.contributor.author Cahn, P.
dc.date.accessioned 2019-04-24T18:23:55Z
dc.date.available 2019-04-24T18:23:55Z
dc.date.issued 2016
dc.identifier.uri http://doi.org/10.7448/IAS.19.1.20684
dc.identifier.uri http://repositorio.upch.edu.pe/handle/upch/6481
dc.description.abstract Introduction: Latinos living with HIV in the Americas share a common ethnic and cultural heritage. In North America, Latinos have a relatively high rate of new HIV infections but lower rates of engagement at all stages of the care continuum, whereas in Latin America antiretroviral therapy (ART) services continue to expand to meet treatment needs. In this analysis, we compare HIV treatment outcomes between Latinos receiving ART in North America versus Latin America. Methods: HIV-positive adults initiating ART at Caribbean, Central and South America Network for HIV (CCASAnet) sites were compared to Latino patients (based on country of origin or ethnic identity) starting treatment at North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) sites in the United States and Canada between 2000 and 2011. Cox proportional hazards models compared mortality, treatment interruption, antiretroviral regimen change, virologic failure and loss to follow-up between cohorts. Results: The study included 8400 CCASAnet and 2786 NA-ACCORD patients initiating ART. CCASAnet patients were younger (median 35 vs. 37 years), more likely to be female (27% vs. 20%) and had lower nadir CD4 count (median 148 vs. 195 cells/μL, p<0.001 for all). In multivariable analyses, CCASAnet patients had a higher risk of mortality after ART initiation (adjusted hazard ratio (AHR) 1.61; 95% confidence interval (CI):1.32 to 1.96), particularly during the first year, but a lower hazard of treatment interruption (AHR: 0.46; 95% CI: 0.42 to 0.50), change to second-line ART (AHR: 0.56; 95% CI: 0.51 to 0.62) and virologic failure (AHR: 0.52; 95% CI: 0.48 to 0.57). Conclusions: HIV-positive Latinos initiating ART in Latin America have greater continuity of treatment but are at higher risk of death than Latinos in North America. Factors underlying these differences, such as HIV testing, linkage and access to care, warrant further investigation.
dc.language.iso eng
dc.publisher Wiley Open Access
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject abacavir
dc.subject anti human immunodeficiency virus agent
dc.subject atazanavir
dc.subject efavirenz
dc.subject emtricitabine
dc.subject lamivudine
dc.subject lopinavir
dc.subject nelfinavir
dc.subject nevirapine
dc.subject stavudine
dc.subject tenofovir
dc.subject zidovudine
dc.subject anti human immunodeficiency virus agent
dc.subject adult
dc.subject Article
dc.subject Canada
dc.subject CD4 lymphocyte count
dc.subject confidence interval
dc.subject controlled study
dc.subject female
dc.subject follow up
dc.subject highly active antiretroviral therapy
dc.subject Hispanic
dc.subject human
dc.subject Human immunodeficiency virus infection
dc.subject major clinical study
dc.subject male
dc.subject men who have sex with men
dc.subject middle aged
dc.subject mortality
dc.subject North America
dc.subject outcome assessment
dc.subject priority journal
dc.subject proportional hazards model
dc.subject South and Central America
dc.subject United States
dc.subject comparative study
dc.subject HIV Infections
dc.subject South America
dc.subject treatment outcome
dc.subject Adult
dc.subject Anti-HIV Agents
dc.subject Canada
dc.subject Female
dc.subject Hispanic Americans
dc.subject HIV Infections
dc.subject Humans
dc.subject Male
dc.subject North America
dc.subject Proportional Hazards Models
dc.subject South America
dc.subject Treatment Outcome
dc.subject United States
dc.title Health outcomes among HIV-positive Latinos initiating antiretroviral therapy in North America versus Central and South America
dc.type info:eu-repo/semantics/article
dc.identifier.journal Journal of the International AIDS Society


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