August 5, 2003
"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.
Most of the patients were between ages 20 and 39. A larger proportion of Central American-born participants were female compared to the Mexican-born and U.S.-born groups. The majority of men were exposed to HIV through male-to-male sex; most of the women were exposed heterosexually. A larger proportion of U.S.-born Latinos were exposed through injection drug use than Mexican- and Central American-born Latinos.
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.