People with HIV see ‘dramatic improvements’ in mortality, but some disparities persist
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Despite significant strides in decreasing mortality among people with HIV over a two-decade period, sex and racial disparities persist, researchers say.
“We know that HIV care and outcomes have dramatically improved over the last 20 years, but disparities still exist at each step of the HIV care continuum that can ultimately lead to differences in mortality rates,” Jessica L. Castilho, MD, MPH, assistant professor of medicine in the division of infectious diseases and assistant professor of health policy at Vanderbilt University Medical Center, told Healio.
“We had the opportunity to examine mortality trends in our clinic, the Vanderbilt Comprehensive Care Clinic. In addition to assessing trends and disparities in mortality, we wanted to look at differences in premature mortality, which has not been as widely studied among populations of people living with HIV,” Castilho said.
Castilho added that this concept could emphasize and quantify the time lost by death at an early age and can expose disparities that are not apparent in the mortality rates alone.
To assess these premature mortality rates, the researchers examined all-cause and premature mortality among people with HIV (PWH) receiving care at the clinic between January 1998 and December 2018.
According to the study, mortality rates were compared by demographic and clinical factors and adjusted incidence rate ratios (aIRRs) were calculated. For those PWH who died, age-adjusted years of potential life lost (aYPLLs) per total person-years living with HIV were also calculated from U.S. sex-specific life tables to further analyze sex and race differences.
Among 6,531 people included in the analysis, 956 (14.6%) died. An adjusted analysis showed that PWH in the most recent calendar years assessed (2014 to 2018) had 78% decreased risk of mortality compared with those in the 1998 to 2003 study period (aIRR = 0.22; 95% CI, 0.17-0.29), whereas women, overall, had an increased risk of death compared with men (aIRR = 1.31; 95% CI, 1.12-1.54).
Additionally, Black women had the highest aYPLLs (592.5; 95% CI, 588.4-596.6]), followed by Black men (470.7; 95% CI, 468.4-472.9), white women (411.5; 95% CI, 405.6-417.4) and white men (308.6; 95% CI, 308-309.2). The researchers added that even adjusted models showed that higher YPLLs remained associated with non-Hispanic Black race and cisgender women, regardless of their individual HIV risk factor.
Overall, Castilho said the study demonstrates “dramatic improvements” in mortality rates among people with HIV, highlighting significant strides that have been made in HIV care in the United States.
Even with these advances, however, she said that persistent disparities in outcomes that make women with HIV, and particularly Black women, experience higher risk of premature death cannot be ignored.
“This research highlights the importance of continued focus on health care disparities,” Castilho said. “We need additional research and implementation of interventions that can address the systemic determinants of these disparities at the individual and community levels.”
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