August 5, 2003
The current study evaluated data on 803 HIV-positive Latinos in Los Angeles to determine differences in risk for specific and total opportunistic infections (OI) by country of origin. Using data from the Adult/Adolescent Spectrum of HIV Disease (ASD), a large CDC-funded observational cohort study conducted in 10 U.S. cities since 1990, researchers compared OI rates among Latinos born in the United States to Latinos born in Mexico and Central America.
"Differences in pre-HAART rates of OIs among HIV-infected U.S. and foreign-born populations have largely been attributed to variation in exposure to etiologic factors by country of birth and inconsistency in diagnostic reporting criteria by region," the researchers wrote. "Few previous studies, however, have had the statistical power to compare HIV disease progression specifically among Latinos born in the United States to Latinos born in Mexico or Central America, and few have examined the differences in acculturation factors for HIV-infected Latinos by country of birth."
ASD collects data on enrolled patients' demographic characteristics, mode of exposure to HIV, previous occurrences of AIDS-related conditions, CD4 counts and viral loads, OI prophylaxis use, antiretroviral use, AIDS- and non-AIDS-related medical conditions, and medical care use. The program reviews patients' records for the past year when they enroll, and follows up at 6-month intervals until the patient dies or stops coming to follow-up appointments. The current study focuses on 803 ASD patients enrolled for at least six months between 1996 and 2000.
In a Cox proportional hazards regression analysis controlling for HAART use, CD4 counts, and age, U.S.-born Latinas were more likely than Central American-born Latinas to develop an OI. In a Poisson regression analysis, U.S.-born Latinos and Latinas were at greater risk for HIV encephalopathy and Kaposi's sarcoma, although the authors cited possible reporting bias from the use of English-based criteria for diagnosing HIV encephalopathy among Spanish-speaking patients. Kaposi's sarcoma is most prevalent in men who have sex with men, and U.S.-born Latinos more often identified as MSM or MSM/IDU than the foreign-born participants.
The researchers noted that variation in exposure to etiologic factors by country of birth appears to play less of a role in OI risk in the HAART era than in pre-HAART days. However, they speculated that increased injection drug and alcohol use and a lower proportion of married persons among U.S.-born Latinos suggest that acculturation factors associated with more high-risk lifestyles and lack of social support may be a factor in elevated OI rates for that group.
"The results of this analysis suggest that risks for OIs are different for U.S.- and foreign-born Latino persons in the HAART era," the authors concluded. "These findings are important as health care providers consider treatment and social support options for patients and [policy planners] consider allocation of resources for HIV health services."
AIDS Patient Care and STDs
06.03; Vol. 17; No. 6: P. 267-275; Amy Rock Wohl, Ph.D.; Sharon Lu, M.P.H.; Jane Turner, M.P.H.; Andrea Kovacs, M.D.; Mallory Witt, M.D.; Kathleen Squires, M.D.; William Towner, M.D.; Victor Beer, M.D.