Antiviral Therapy Use Varies by Gender and Ethnic Groups

Overall use of antiretroviral therapy (ART) is high among both men and women, but women of all races and ethnicities are less likely to take ART than men, according to a new study.

“Women may be more likely to discontinue ART than men,” said lead author Linda Beer, PhD, an epidemiologist from the CDC in Atlanta. She noted that "women comprise one-quarter of all persons living with HIV in the United States. The majority are black or Hispanic/Latina."

Female gender and non-white race/ethnicity are often found to be associated with lack of viral suppression and poor clinical outcomes. “Consideration of both gender and race/ethnicity is needed to identify areas for targeted intervention to improve outcomes that are relevant to specific groups of women,” she said.

Dr Beer and colleagues analyzed data from the Medical Monitoring Project, an ongoing surveillance system for HIV-positive adults receiving care in the US. The researchers reviewed interview and medical record data from a cohort of 8169 HIV-infected adults receiving care in 16 US states and Puerto Rico. The study included more men (91%) than women (85%) who were taking ART. Black people were significantly less likely to be receiving ART (86%) than Hispanic (91%) or white people (92%).

The rate of viral suppression, which was defined as a viral load below 200 copies/mL, was higher in men (74%) than in women (69%), she reported. Among whites, the rate of viral suppression was also significantly higher in men (81%) than in women (74%). Among those being treated with ART, rates of viral suppression were the same in men and women of the same race. There was no significant difference in viral suppression between men and women for the black and Hispanic patients.

Women and men were equally likely to report ever having taken ART, but the rate of ART discontinuation was higher in black women (7%) than in black men (4%) and in white women (8%) than in white men (3%). The rate of discontinuation could not be compared in Hispanics due to low numbers, she noted.

"Most women and men reported not taking ART based on advice from their health-care providers," Dr Beer said. Although ART use is high, about one-third of women and one-quarter of men receiving medical care have not achieved viral suppression. Also, she noted that “there are disparities in rates of viral suppression between white men and among racial/ethnic groups. Among those taking ART, men and women of the same race/ethnicity did equally well.”

In conclusion, Dr Beer said that “adjusting for sociodemographic, behavioral, and clinical factors reduced but did not eliminate gender differences in ART use. Decreasing gender disparities in viral suppression may require better understanding of barriers to ART use among women and reducing racial/ethnic disparities in viral suppression.”

Dr Beer presented the results on June 9, 2014 at the 9th International Conference on HIV Treatment and Prevention Adherence in Miami. (Abstract 283)