Race and mental health diagnosis are risk factors for highly active antiretroviral therapy failure in a military cohort despite equal access to care

BACKGROUND: Data suggest that African Americans have lower rates of virologic suppression using highly active antiretroviral therapy (HAART), possibly because of socioeconomic status and access to care. In a US Military clinic, where beneficiaries have ready access to no-cost health care, the impact of several variables (including race) on HIV virologic suppression were examined. METHODS: Retrospective analysis of antiretroviral-naive patients who began HAART between 1997 and 2003. Demographics, viral loads, CD4 cell counts, and mental health diagnoses were analyzed. RESULTS: The charts of 129 individuals who initiated their first antiretroviral regimen during the period of observation were evaluated. The overall efficacy of reaching viral suppression was 71% at 12 months and 56% at 24 months. HIV suppression was achieved at 12 months by 63% of African Americans and 92% of whites (P = 0.001). Mental health diagnosis was associated with failure at 24 months (38 vs. 61%; P = 0.034). Being white (odds ratio = 3.5, 95% confidence interval [CI]: 1.2 to 10.3; P = 0.022) and lacking a mental health diagnosis (odds ratio = 8.7, 95% CI: 2.4 to 32.1; P = 0.001) were both associated with increased efficacy at 24 months by multivariate analysis. CONCLUSIONS: African-American race and the presence of a mental health diagnoses were independently associated with antiretroviral failure. Equal access to care yields high efficacy rates with HAART but does not fully equilibrate racial differences in virologic failure.