HIV treatment outcomes among gay men in the UK are similar
across ethnic groups, investigators report in the online edition of the Journal of Acquired Immune Deficiency
The study showed that gay men from black and minority ethnic
(BME) populations were approximately 17% less likely to initiate antiretroviral
therapy than white gay men. However, after starting treatment there were no
differences by ethnicity in treatment outcomes.
“The provision through the NHS [National Health Service] of
publicly funded HIV care with universal access has resulted in equitable
utilisation and outcomes of HIV care across different ethnic MSM [men who have
sex with men] groups,” comment the investigators. “Nevertheless we have shown
that there are disparities in the uptake of cART [combination antiretroviral
therapy] and the reasons for this warrant further study.”
Gay men remain one of the groups most affected by HIV in the
UK. Prevalence of the infection differs significantly according to ethnicity
and is higher among BME gay men compared to white gay men.
US research showed that differences in health insurance
status meant that MSM from minority racial populations were less likely to
access healthcare compared to white MSM.
In the UK, however, the NHS provides universal and equitable
access to healthcare. Despite this, there is some evidence suggesting that BME
patients are more likely to report dissatisfaction with their care and longer
waiting times for appointments.
Investigators from the UK Collaborative HIV Cohort (UK CHIC)
therefore analysed differences in retention in HIV care, uptake of
antiretroviral therapy and HIV treatment outcomes between MSM according to
The study involved 16406 gay male patients who received care between
1996 and 2008. The analysis of HIV treatment utilisation was restricted to
individuals who were seen after 2000. Examination of treatment outcomes was
restricted to the subgroups of individuals who received care after 2007.
Most of the patients (89%) were classified as white. The
1818 (11%) BME individuals were divided into six racial and ethnic groups:
Restricting analysis to BME patients showed that CD4 cell
counts at the time of presentation to care were highest among patients of
Indian/Pakistani/Bangladeshi origin and lowest among black Africans and
individuals classified as Asian/Oriental (p = 0.0001).
The proportion of men with no recorded follow-up after
diagnosis with HIV was small. However, it was higher among BME men than white
men (3% vs. 2%, p = 0.002).
In total, 6338 patients initiated HIV therapy. CD4 cell
counts at the time of treatment initiation were significantly lower among BME
gay men compared to white gay men (206 vs. 224 cells/mm3, p = 0.003).
The investigators calculated that BME gay men were 17% less
likely to start HIV therapy than white gay men, a significant difference (p =
“Despite the widespread availability of free healthcare and
cART in the UK we found that BME MSM were less likely than white MSM to
initiate cART,” write the authors.
Despite this, there were no significant differences in
treatment outcomes between BME and white patients.
One year after starting treatment, equal proportions of BME
and white patients had an undetectable viral load (85% vs. 86%). The time to
virological suppression was similar between the two groups (3.9 vs. 4.2
months). Twelve-month increases in CD4 cell were also comparable between BME
and white patients (182 cells/mm3 vs. 186 cells/mm3).
Nor did rates of disease progression differ according to
ethnicity. In all 6% of BME gay men developed a new AIDS defining illness or
died compared to 5% of white gay men.
“This study demonstrates that despite BME MSM being a
‘minority within a minority’ for those HIV infected there are few ethnic
disparities in access to care and treatment outcomes in our setting,” conclude