A patient’s ethnicity, gender and sexuality do not appear to influence the uptake of antiretroviral therapy, according to a study conducted in the United Kingdom and presented to the Sixteenth International AIDS Conference in Toronto last week.
In the UK, the two groups most affected by HIV are gay men and Africans. It is well known that Africans are significantly more likely than gay men to have their HIV infection diagnosed when they are already ill because of HIV. Investigators from the City University in London and Homerton University Hospital in north east London wished to see if the uptake of antiretroviral therapy among individuals with diagnosed HIV infection differed according to ethnicity, gender or sexual orientation.
UK HIV treatment guidelines recommend that everyone who has symptoms of HIV infection should start potent antiretroviral therapy, and that anti-HIV treatment should be started by everybody whose CD4 cell count has fallen to between 250 – 200 cells/mm3.
A total of 1,687 patients were included in a study that was conducted between the summers of 2004 and 2005. All the patients were receiving free NHS HIV treatment and care at the Homerton Hospital and completed a confidential, self-administered questionnaire.
The study population was ethnically mixed and comprised 704 black Africans (480 of whom were women), and 758 gay men (646 of whom were white).
Antiretroviral therapy was being taken by 71% of gay men, 75% of African women and 80% of African heterosexual men. There was a statistically significant difference in the proportion of African heterosexual men and gay men taking anti-HIV treatment (p < 0.05).
But when the investigators controlled for most recent CD4 cell count, they found that there was no significant difference in the uptake of anti-HIV therapy by ethnicity, gender or sexual orientation. This suggests that once HIV infection is diagnosed, patients from the two main risk groups are equally likely to receive HIV treatment according to current UK treatment guidelines.
There was good evidence that UK treatment guidelines were being observed at the hospital, as a CD4 cell count below 200 cells/mm3 and physical symptoms of HIV infection were both factors significantly associated with the use of HIV therapy (p < 0.001).
However, African heterosexual patients were significantly more likely than gay men to have a CD4 cell count below 200 cells/mm3: 12% of white gay men had a CD4 cell count below this level, compared to 14% of gay men from ethnic minorities, 24% of African women and 28% of African heterosexual men (p < 0.01).
The results of this study suggest that once HIV infection is diagnosed, patients from the two main risk groups are equally likely to receive HIV treatment according to current UK treatment guidelines.
Elford J et al. Treatment and care for people living with HIV in London: ethnicity, gender and sexual orientation. Sixteenth International AIDS Conference, Toronto, abstract TUPE0234, 2006.