Treatment outcomes in undocumented Hispanic immigrants with HIV infection

PLoS One. 2013;8(3):e60022. doi: 10.1371/journal.pone.0060022. Epub 2013 Mar 26.

Abstract

Objective: Little is known about the treatment outcomes of undocumented Hispanic immigrants with HIV infection. We sought to compare the treatment outcomes of undocumented and documented patients 12-months after entering HIV care.

Methods: We conducted a retrospective cohort study of antiretroviral-naive patients 18 years and older attending their first visit at Thomas Street Health Center in Houston, Texas, between 1/1/2003 and 6/30/2008. The study population of 1,620 HIV-infected adults included 186 undocumented Hispanic, 278 documented Hispanic, 986 Black, and 170 White patients. The main outcome measures were retention in care (quarter years with at least one completed HIV primary care provider visit) and HIV suppression (HIV RNA <400 copies/mL), both measured 12-months after entering HIV care.

Results: Undocumented Hispanic patients had lower median initial CD4 cell count (132 cells/mm(3)) than documented Hispanic patients (166 cells/mm(3); P = 0.186), Black patients (226 cells/mm(3); P<0.001), and White patients (264 cells/mm(3); P = 0.001). However, once in care, undocumented Hispanic patients did as well or better than their documented counterparts. One year after entering HIV care, undocumented Hispanics achieved similar rates of retention in care and HIV suppression as documented Hispanic and White patients. Of note, black patients were significantly less likely to have optimal retention in care (adjusted odds ratio [aOR] 0.65, CI = 0.45-0.94) or achieve HIV suppression (aOR 0.32, CI = 0.17-0.61) than undocumented Hispanics.

Conclusions: Undocumented Hispanic persons with HIV infection enter care with more advanced disease than documented persons, suggesting testing and/or linkage to care efforts for this difficult-to-reach population need intensification. Once diagnosed, however, undocumented Hispanics have outcomes as good as or better than other racial/ethnic groups. Safety net providers for undocumented immigrants are vital for maintaining individual and public health.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Emigrants and Immigrants / statistics & numerical data
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome

Grant support

This material is based upon work supported in part by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Houston VA Health Services Research and Development Center of Excellence (HFP90-020). This material was also supported in part by the facilities and resources of Harris Health System, Houston, Texas. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.