Regimen switching after initial haart by race in a military cohort

Background: Prior studies have suggested that HAART switching may vary by ethnicity, but these associations may be confounded by socioeconomic differences between ethnic groups. Utilizing the U.S. military healthcare system, which minimizes many socioeconomic confounders, we analyzed whether HAART switching varies by race/ethnicity. Methods: HAART-naïve participants in the U.S. Military HIV Natural History Study who initiated HAART between 1996-2012 and had at least 12-months of follow-up were assessed for factors associated with HAART regimen change (e.g. NNRTI to PI) within one year of initiation. Multiple logistic regression was used to compare those who switched versus those who did not switch regimens. Results: 2457 participants were evaluated; 91.4% male, 42.3% Caucasian, 42.8% African-American, and 9% Hispanic. In a multivariate analysis, African-Americans had lower odds (OR 0.76, 95% CI 0.65, 0.98) while Hispanics had no significant difference with respect to HAART switching compared to Caucasians; however, Other race was noted to have higher odds (OR 1.77, 95% CI 1.11, 2.83). Additional significantly associated factors included CD4 <200 cells/uL at HAART initiation, higher viral load, prior ARV use, and history of depression. Conclusion: In this cohort with open access to healthcare, African-American and Hispanic races were not associated with increased odds of switching HAART regimen at 12 months, but Other race was. The lack of association between race/ethnicity and regimen change suggest that associations previously demonstrated in the literature may be due to socioeconomic or other confounders which are minimized in the military setting.