A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)

Jodie L. Guest, Amy C. Weintrob, David Rimland, Christopher Rentsch, William P. Bradley, Brian K. Agan, Vincent C. Marconi, Susan Banks, Mary Bavaro, Ionut Bebu, Helen Chun, Nancy Crum-Cianflone, Cathy Decker, Conner Eggleston, Tomas Ferguson, Susan Fraser, Joshua Hartzell, Joshua Hawley, Gunther Hsue, Arthur JohnsonMark Kortepeter, Tahaniyat Lalani, Robbin Lockhart, Grace Macalinio, Scott Merritt, Octavio Mesner, Robert O'Connell, Maj Jason Okulicz, Sheila Peel, Michael Polis, John Powers, Roseanne Ressner, Edmund Tramont, Tyler Warkentien, Amy Weintrob, Timothy Whitman, Michael Zapor

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Introduction: The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence. Methods: Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS) and 1199 patients from the US Military HIV Natural History Study (NHS). Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event. Results: Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only) and 26.8% to 4.1% (combined mortality or AIDS) when controlling for clinical and demographic variables. Conclusion: We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.

Original languageEnglish (US)
Article numbere62273
JournalPloS one
Volume8
Issue number5
DOIs
StatePublished - May 1 2013

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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    Guest, J. L., Weintrob, A. C., Rimland, D., Rentsch, C., Bradley, W. P., Agan, B. K., Marconi, V. C., Banks, S., Bavaro, M., Bebu, I., Chun, H., Crum-Cianflone, N., Decker, C., Eggleston, C., Ferguson, T., Fraser, S., Hartzell, J., Hawley, J., Hsue, G., ... Zapor, M. (2013). A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS). PloS one, 8(5), [e62273]. https://doi.org/10.1371/journal.pone.0062273