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In a retrospective sub study using the Veterans Administration (VA) database, the authors looked at health disparities in the treatment of common comorbidities among HIV-infected veterans. It is known that health disparities exist between black and non-black HIV-infected patients; blacks are less likely to be in care, to receive ART and to have viral load suppression. The authors looked at the cohort of approximately 25,000 HIV-infected veterans in care during 2013. Three-quarters of these patients were over the age of 50 and 13% of the black patients and 22% of the white patients were over the age of 65. They compared the data on HIV care between black and non-black veterans, assessing common comorbidities such as diabetes, hypertension and hyperlipidemia, mental health, substance abuse and neighborhood social disadvantage. They found significant greater prevalence of hypertension, diabetes, substance abuse, hepatitis C, and chronic kidney disease among black veterans, along with more neighborhood social disadvantage based on living location. In looking at the management of the comorbidities, there was significantly less achievement of recognized target goals in ART use, viral load, hypertension, diabetes and hyperlipidemia. Despite equal access in the VA system, health disparities in the treatment of HIV and comorbidities exist, even when patient characteristics or neighborhood social disadvantage are controlled. The authors suggest several solutions, such as programs to reduce racial disparities and further evaluation of interventions in place.
Jonathan S. Appelbaum, MD, FACP, AAHIVM