Journal Article

Trends and Disparities in Mortality and Progression to AIDS in the Highly Active Antiretroviral Therapy Era: Tennessee, 1996–2016

Mathieson, Samantha A., Wester, Carolyn, Sterling, Timothy R., Sizemore, Lindsey, Kipp, Aaron, Shepherd, Bryan E., Rebeiro, Peter F., Pettit, April C.

2019

Overview

Objectives. To use statewide surveillance data to examine trends and disparities in mortality and progression from HIV to AIDS comprehensively in Tennessee over the past 20 years. Methods. Individuals diagnosed with HIV in Tennessee from 1996 to 2016 were identified through the Tennessee Department of Health Enhanced HIV/AIDS Reporting System. Clinical AIDS and all-cause mortality were the outcomes. Cox regression yielded adjusted hazard ratios (AHRs) for death and competing risk regression yielded adjusted subhazard ratios (SHRs) for AIDS, with death as the competing event. Results. Individuals with a history of heterosexual contact (AHR = 1.20; 95% confidence interval [CI] = 1.12, 1.29) and injection drug use (AHR = 1.27; 95% CI = 1.18, 1.38) had increased hazards of death relative to those with a history of male-to-male sexual contact. Hazards of death were lower among White (AHR = 0.79; 95% CI = 0.73, 0.85) and Hispanic (AHR = 0.50; 95% CI = 0.40, 0.63) individuals than among Black individuals. Those with heterosexual contact (SHR = 1.20; 95% CI = 1.12, 1.29) and injection drug use (SHR = 1.27; 95% CI = 1.18, 1.38) had a greater risk of AIDS than those with male-to-male sexual contact. White individuals (SHR = 0.85; 95% CI = 0.81, 0.90) had a lower risk of AIDS than Black individuals, and female individuals (SHR = 0.84; 95% CI = 0.79, 0.90) had a lower risk than male individuals. Conclusions. The trends, disparities, and outcomes assessed in our study will inform HIV testing and care linkage program design and implementation in Tennessee.

• Publisher: American Public Health Association
• Subject: Acquired immune deficiency syndrome / Acquired Immunodeficiency Syndrome - epidemiology / Acquired Immunodeficiency Syndrome - mortality / Adult / AIDS / AJPH Open-Themed Research / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Antiretroviral Therapy, Highly Active / Black people / Competing risks models / Confidence intervals / Death / Death & dying / Disease Progression / Disease transmission / Drug abuse / Drug therapy / Drug use / Epidemiology / Female / Follow-Up Studies / Hazards / Health care policy / Health hazards / Health surveillance / Heterosexuality / Highly active antiretroviral therapy / Hispanic people / HIV / HIV/AIDS / Human immunodeficiency virus / Humans / Injection / Male / Males / Medical tests / Medical treatment / Middle Aged / Mortality / Other Race/Ethnicity / Population / Prescription drugs / Public health / Racial differences / Ratios / Risk / Sexual behavior / Sexually transmitted diseases / Statistical analysis / STD / Surveillance / Tennessee - epidemiology / Tests / Trends / Young Adult