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Ethnic differences in hiv disease progression: a comparison of Asian/Pacific Islanders and Whites living in Hawaii.

OBJECTIVE
To characterize the association of demographic factors with the relative hazards (RH) of developing AIDS or death among HIV-infected individuals of Asian/Pacific Islander (API) ethnicity and Whites.


DESIGN
Cohort study


SETTING
Hawaii State Health Department database of HIV-infected individuals


PATIENTS OR PARTICIPANTS
Hawaii Sero-Positivity and Medical Management (HSPAMM) program participants from January 1989 to November 2002


INTERVENTIONS
None


MAIN OUTCOME MEASURES
Differences in the time to develop AIDS or death among HIV-infected individuals who reported being on highly active antiretroviral treatment (HAART) were examined by ethnicity, income, and CD4+ cell counts at HAART initiation by using Kaplan-Meier survival analysis and Cox proportional hazard analyses.


RESULTS
The study was based on 516 HIV-infected individuals, who were primarily White (61.0%) and API (21.7%). Whites had a significantly higher CD4+ cell count (P<.01) and income (P<.01) than APIs at enrollment into HSPAMM. Lower income levels and CD4+ cell counts at HAART initiation were strongly associated with an increased RH of developing AIDS or dying. Despite having significantly lower incomes and CD4+ cell counts at enrollment, individuals of API ethnicity do not have an increased RH of developing the outcomes compared to Whites.


CONCLUSION
Lower income and CD4+ cell counts at HAART initiation significantly increased the RH of developing AIDS or dying among HIV-infected individuals. Asian/Pacific Islander (API) ethnicity was not a predictor of developing AIDS or dying.