Similar HIV treatment outcomes among UK gay men across ethnic groups

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 Syndromes.

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 ethnicity.

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:

• Black Caribbean (21%)

• Black African (13%)

• Black other (15%)

• Indian/Pakistani/Bangladeshi (8%)

• Other Asian/Oriental (14%)

• Other/mixed (29%)

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 = 0.0002).

“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 the investigators.