OBJECTIVE We investigated differences in clinical outcomes in heterosexual participants, by ethnicity in the UK Collaborative HIV Cohort Study from 2000-2017. DESIGN Cohort analysis. METHODS Logistic/Proportional hazard regression assessed ethnic… Click to show full abstract
OBJECTIVE We investigated differences in clinical outcomes in heterosexual participants, by ethnicity in the UK Collaborative HIV Cohort Study from 2000-2017. DESIGN Cohort analysis. METHODS Logistic/Proportional hazard regression assessed ethnic group differences in CD4+ cell count at presentation, engagement-in-care, combination antiretroviral therapy (cART) initiation, viral suppression and rebound. RESULTS Of 12,302 participants (median age: 37 [interquartile range: 31, 44] years, 52.5% women, total follow-up: 85,846 person-years), 64.4% were Black African, 19.1% White, 6.3% Black Caribbean, 3.6% Black Other, 3.3% South Asian/Other Asian and 3.4% Other/Mixed. CD4+ cell count at presentation amongst participants from non-White groups were lower than the White group. Participants were engaged-in-care for 79.6% of follow-up time, however Black and Other/Mixed groups were less likely to be engaged-in-care than the White group (adjusted odds ratios vs. White: Black African: 0.70 [95% confidence interval 0.63, 0.79], Black Caribbean: 0.74 [0.63, 0.88], Other/Mixed: 0.78 [0.62, 0.98], Black Other: 0.81 [0.64, 1.02]). Of 8,867 who started cART, 79.1% achieved viral suppression, with no differences by ethnicity in cART initiation or viral suppression. Viral rebound (22.2%) was more common in the Black Other (1.95 [1.37, 2.77]), Black African (1.85 [1.52, 2.24]), Black Caribbean (1.73 [1.28, 2.33]), South Asian/Other Asian (1.35 [0.90, 2.03]) and Other/Mixed (1.09 [0.69, 1.71]) groups than in White participants. CONCLUSIONS Heterosexual people from Black, Asian and minority ethnic groups presented with lower CD4+ cell counts, spent less time engaged-in-care and were more likely to experience viral rebound than White people. Work to understand and address these differences is needed.
               
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