Differential survival in blacks and Hispanics with AIDS

Country of birth does not influence long-term clinical, virologic, and immunological outcome of HIV-infected children living in the Netherlands: a cohort study comparing children born in the Netherlands with children born in Sub-Saharan Africa

BACKGROUND

Immigrant HIV-infected adults in industrialized countries show a poorer clinical and virologic outcome compared with native patients. We aimed to investigate potential differences in clinical, immunological, and virologic outcome in Dutch HIV-infected children born in the Netherlands (NL) versus born in Sub-Saharan Africa (SSA) in a national cohort analysis.

METHODS

We included all HIV-infected children registered between 1996 and 2013. Descriptive statistics, mixed-effects models, and Cox proportional hazard models were used to investigate differences between groups.

RESULTS

In total, 319 HIV-infected children were registered. The majority of these children were born in SSA (n = 148, 47%) or NL (n = 113, 36%) and most were black (n = 158, 61%). Children born in NL were diagnosed at a median age of 1.2 years and initiated combination antiretroviral therapy (cART) at a median age of 2.6 years, compared with 3.7 and 5.3 years, respectively, for children born in SSA (HIV diagnosis: P < 0.001; cART initiation: P < 0.001). Despite a lower initial CD4 T-cell Z-score in children born in SSA, their immunological reconstitution was similar to children from NL. Virologic suppression was achieved in the majority of all cART-treated children (NL: 96%, SSA: 94%). There was no difference in the occurrence or timing of virologic failure.

CONCLUSIONS

Most immigrant HIV-infected children living in NL were born in SSA. Children born in SSA were diagnosed and initiated cART at an older age than children born in NL. Despite initial differences in CD4 T-cell counts and HIV viral load, the long-term immunological and virologic response to cART was similar in both groups.

Insights into the ethnic differences in serum ferritin between black and white US adult men

Although higher serum ferritin (SF) concentrations have been consistently observed among blacks, despite their lower hemoglobin (Hb) concentrations compared with whites, few studies attempted to explain this SF difference. To determine the possible factors contributing to the observed SF difference between blacks and whites, 1,938 non-Hispanic white (NHW) and 1,616 non-Hispanic black (NHB) male subjects, aged 20-65 years were selected from the third National Health and Nutrition Examination Survey (NHANES III). Multiple regression analysis was used to examine the contribution of dietary, biochemical, and socioeconomic variables to the observed SF difference between the two groups. NHB subjects showed a continuing, significantly higher SF concentration compared with NHW subjects at each age group. Age, serum total protein, mean cell volume (MCV), and gamma glutamyl transferase (GGT) were positively associated with SF, whereas percent energy from carbohydrate and fat, calcium intake, serum alpha-carotene, and iron binding capacity (TIBC) were inversely associated with SF (P < 0.01). After excluding subjects with abnormal serum total protein, TIBC and GGT levels from the analysis (the final regression model), the SF difference dropped to 3.95 microg/l (initial difference = 37.1 microg/l) between NHWs and NHBs. The results suggest that the oft-noted black-white SF difference is a result of factors including overall nutrition and health, iron status, and hepatic well-being. Higher SF, low Hb, and reduced TIBC level observed in blacks are consistent with the definition of anemia of chronic disease (ACD). Future investigations are needed to confirm the role of ACD in the black-white SF difference.

Ethnic difference in the relationship between acute inflammation and serum ferritin in US adult males

This study examined the ethnic difference in the association between increased serum ferritin (SF) (>300 microg/l) and acute inflammation (AI) (C-reactive protein > or = 1.0 mg/dl) between black and white males aged > or = 20 years. Using data from the third National Health and Nutrition Examination Survey (NHANES III), we determined the risk for having elevated SF in black males (n=164) and white males (n=325) with AI present as well as black males (n=1731) and white males (n=2877) with AI absent. Black subjects with AI present were 1.71 times (95% CI 1.18-2.49), and 1.87 times (95% CI 1.46-2.40) more likely to have increased SF than AI absent blacks and AI present whites, respectively. Furthermore, with AI present, every increment of C-reactive protein, white blood cell count, serum albumin, lymphocyte count and platelet count was associated with higher odds of having elevations in SF in blacks than whites. Regardless of AI status, blacks were more likely to have elevations in SF than whites, and the prevalence of elevated SF was significantly higher in blacks than whites. This finding suggested that black males may respond to inflammation with a more aggressive rise in SF compared to white males. Future research is needed to investigate the underlying mechanisms.

Characteristics of persons with heterosexually acquired HIV infection, United States 1999-2004

OBJECTIVES

In the United States a growing proportion of cases of heterosexually acquired HIV infections occur in women and in persons of color. We analyzed the association between race/ethnicity, whether diagnoses of HIV infection and AIDS were made concurrently, and the survival after diagnosis of heterosexually acquired AIDS.

METHODS

We used data from 29 states that report confidential name-based HIV/AIDS cases to the Centers for Disease Control and Prevention to calculate estimated annual percentage change in the number of actual diagnoses and analyzed the association between race/ethnicity and concurrent diagnoses of HIV and AIDS. We adjusted for reporting delays and absence of information about HIV risk factors.

RESULTS

During 1999 to 2004, diagnoses of heterosexually acquired HIV were made for 52 569 persons in 29 states; 33 554 (64%) were women. Among men and women, 38 470 (73%) were non-Hispanic Black; 7761 (15%), non-Hispanic White; and 5383 (10%), Hispanic. The number of persons with heterosexually acquired HIV significantly increased: 6.1% among Hispanic men (95% confidence interval=2.7, 9.7) and 4.5% among Hispanic women (95% confidence interval=1.8, 7.3). The number significantly decreased (-2.9%) among non-Hispanic Black men. Concurrent HIV and AIDS diagnoses were slightly more common for non-Hispanic Whites (23%) and Hispanics (23%) than for non-Hispanic Blacks (20%).

CONCLUSIONS

To decrease the incidence of heterosexually acquired HIV infections, prevention and education programs should target all persons at risk, especially women, non-Hispanic Blacks, and Hispanics.

Effectiveness of highly-active antiretroviral therapy by race/ethnicity

OBJECTIVE

To determine the effectiveness of HAART by race/ethnicity.

DESIGN

Prospective multicenter cohort study.

METHODS

We studied 991 African-Americans and 911 European-Americans enrolled in the United States Military's Tri-Service AIDS Clinical Consortium Natural History Study who had dates of HIV seroconversion known within 5 years and followed between 1990 and 2002. We determined the rate of disease progression to AIDS and death for subjects in this cohort. Multivariable models evaluated race, pre-HAART (1990-1995) and HAART (1996-2002) eras, age, gender and military service.

RESULTS

In the pre-HAART era, African-Americans had a statistically nonsignificant trend towards better outcomes: the relative hazards (RH) of AIDS and death for African-Americans compared to European-Americans were 0.85 [95% confidence interval (CI), 0.68-1.05] and 0.77 (95% CI, 0.55-1.08), respectively. In the HAART era, outcomes were similar by race: 1.17 (95% CI, 0.86-1.61) for AIDS and 1.11 (95% CI, 0.81-1.53) for death with overlapping Kaplan-Meier curves. Relative to the pre-HAART era, the adjusted RH of AIDS in the HAART era was 0.41 (95% CI, 0.31-0.54) and 0.30 (95% CI, 0.22-0.40) for African-American and European-American participants, respectively. Analogous RH for death were 0.55 (95% CI, 0.38-0.80) and 0.38 (95% CI, 0.27-0.54). The precipitous declines in AIDS and death in the HAART era were not statistically different by race.

CONCLUSIONS

: In a large multi-racial cohort with equal access to health care, HIV treatment outcomes by race/ethnicity were similar.

Psychosocial differences between whites and African Americans living with HIV/AIDS in rural areas of 13 US states

CONTEXT

Acquired immunodeficiency syndrome (AIDS) prevalence rates are increasing rapidly in rural areas of the United States. As rural African Americans are increasingly affected by human immunodeficiency virus (HIV), it is important to identify psychosocial factors unique to this group so that AIDS mental health interventions can be culturally contextualized to meet their unique needs.

PURPOSE

The current study characterized psychosocial functioning in 43 rural African Americans living with HIV/AIDS and compared their levels of functioning to those of 196 HIV-infected rural white persons.

METHODS

All participants were recruited through AIDS service organizations in 13 US states. Surveys were completed as part of a preintervention phase of a randomized clinical trial evaluating 2 mental health interventions for HIV-infected rural persons.

FINDINGS

Compared to their white counterparts, fewer African Americans had progressed to AIDS. African American participants also reported higher levels of coping self-efficacy, more support from family members, and marginally fewer depressive symptoms, and they engaged in more active coping. African Americans who had greater HIV disease severity also received less support from family members and experienced more loneliness.

CONCLUSIONS

Study findings caution that rural African Americans and whites living with HIV disease should not be considered a homogeneous group.

Comprehensive Analysis of Genetic Polymorphisms in the Interleukin-10 Promoter: Implications for Immune Regulation in Specific Ethnic Populations

The association of interleukin-10 (IL-10) promoter single-nucleotide polymorphisms (SNPs) as risk factors for certain inflammatory diseases, viral infections, cancers, and transplant rejection have been the subject of recent studies. The SNPs -1082 G --> A, -819 C --> T, and -592 C --> A, which have been associated with differential IL-10 production, are strongly linked with ethnicity. In this study, we determined the ethnic distribution of IL-10 promoter SNPs and their haplotype rates among Hispanics, African Americans, and Caucasians from Texas and Ashkenazi Jews from New York. Significant differences in prevalence rates of IL-10 SNPs (and their haplotype distribution) were found. African Americans and Hispanics have a lower rate of putative high-producer SNPs and a higher rate of low IL-10 producers when compared to Caucasians or Ashkenazi Jews. No statistically significant differences in allelic frequencies and haplotype rates were observed between Caucasians and Ashkenazi Jews. This study provides critical new information on the ethnic distribution of IL-10 promoter SNPs in a regional U. S. population and is the first to analyze the rate of SNPs in an unstudied ethnic population, Ashkenazi Jews. Knowledge of IL-10 promoter polymorphisms may prove useful in prediction of immunization responses, disease severity, and in the intelligent design of customized immunotherapy.

Racial/ethnic differences in CD4 T cell count and viral load at presentation for medical care and in follow-up after HIV-1 infection

The baseline characteristics of antiretroviral-naive patients were compared by ethnic/racial groups. First CD4 T cell counts were lower for Latino (P = 0.0004) and black patients (P = 0.10) when compared with white patients. First HIV-1-RNA levels were higher in Latino patients (P = 0.08), who were also more likely to present with major opportunistic infections (P < 0.004). Once in care, changes in CD4 T cell counts and viral loads over time did not differ significantly between groups.

Association of age, sex, and race with body iron stores in adults: analysis of NHANES III data

BACKGROUND

This study examined age-, sex-, and race- related increases in body iron stores that have been implicated in disease and the relative utility of the serum ferritin versus the percentage of transferrin saturation for population-based estimation of iron status.

METHODS AND RESULTS

Serum ferritin levels were examined by age, sex, and race, and values were compared with the percent transferrin saturation in 20,040 individuals >17 years of age from the third National Health and Nutrition Examination Survey (NHANES III) database. Body iron stores reflected by serum ferritin levels rose in the late teens in men and after menopause in women. This rise was more rapid and maximum ferritin levels were greater for blacks than whites and Hispanics of comparable age and sex. The distribution of values for the serum ferritin differed from the percent transferrin saturation.

CONCLUSIONS

Different patterns of iron accumulation exist according to age, sex, and race. Serum ferritin levels reflect graded, population-based differences in body iron stores, but the percentage of transferrin saturation does not. The hypothesis that iron accumulation may contribute to higher morbidity and mortality rates can be tested in clinical trials of calibrated reduction of body iron stores in defined disease settings.