We investigated differences in retention in HIV care and uptake of cART and treatment outcomes between different ethnic MSM groups.
MSM subjects with known ethnicity and ≥1 day follow-up from 1996-2009 in the UK CHIC Study were included. Black and minority ethnic (BME) men were categorized as: Black; Indian/Pakistani/Bangladeshi ; other Asian/Oriental; and Other/mixed. Logistic regression was used to identify factors associated with treatment initiation within the 6 months after each CD4 count . HIV viral load, CD4 counts, discontinuation/switch of a drug in the initial cART regimen and development of a new AIDS event/death at 6 and 12 months were also analysed.
Of 16406 MSM, 1818 (11.0%) were BME; 892 (49.1%) black, 139 (7.6%) I/P/B, 254 (13.9%) other Asian/Oriental, 532 (29.2%) Other/mixed. The proportion of MSM with no follow-up after HIV diagnosis was higher among BME than white MSM (3.4% vs 2.2%, p=0.002). Permanent loss to follow-up was highest in the Other/mixed and lowest in Indian/Pakistani/Bangladeshi groups (p=0.02). 6338 MSM initiated first cART from 1/1/2000-1/1/2009. In multivariable analyses, BME MSM were 18% less likely to initiate cART than white MSM with similar CD4 counts (adjusted odds ratio 0.82 [95% confidence interval 0.74, 0.91], p=0.0001). However, once on cART there were no differences in virological, immunological and clinical outcomes. .
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 and treatment outcomes in our setting.
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