Document 0168
 DOCN  M9440168
 TI    Racial differences in the use of drug therapy for HIV disease in an
       urban community.
 DT    9404
 AU    Moore RD; Stanton D; Gopalan R; Chaisson RE; Johns Hopkins University
       School of Medicine, Baltimore, MD 21205.
 SO    N Engl J Med. 1994 Mar 17;330(11):763-8. Unique Identifier : AIDSLINE
       MED/94150551
 AB    BACKGROUND. Guidelines for drug therapy in human immunodeficiency virus
       (HIV) disease are based primarily on the stage of the disease. To
       determine whether sociodemographic characteristics of patients influence
       drug therapy in practice, we analyzed the use of antiretroviral therapy
       and prophylactic therapy for Pneumocystis carinii pneumonia (PCP) in an
       urban population infected with HIV. METHODS. All patients presenting for
       the first time to our HIV clinic from March 1990 through December 1992
       were enrolled. Data on sociodemographic and clinical variables and on
       drug use were collected at the time of presentation and after six
       months. We asked whether patients with CD4+ cell counts of 500 or less
       per cubic millimeter were receiving antiretroviral therapy at the time
       of presentation, and whether patients with CD4+ cell counts of 200 or
       less per cubic millimeter were receiving PCP prophylaxis. RESULTS. Among
       the 838 patients enrolled, 656 (79 percent) were blacks, 167 (20
       percent) were non-Hispanic whites, and 15 (2 percent) were Asian or
       Hispanic descent or were not racially classified. There were no racial
       differences in the stage of HIV disease at the time of presentation.
       However, there were racial disparities in the receipt of antiretroviral
       therapy: 63 percent of eligible whites but only 48 percent of eligible
       blacks received such therapy (P = 0.003). PCP prophylaxis was received
       by 82 percent of eligible whites but only 58 percent of eligible blacks
       (P < 0.001). There were no significant differences in the receipt of
       drug therapy with respect to age, sex, mode of HIV transmission, type of
       insurance, income, education, or place of residence. In a
       logistic-regression analysis, race was the feature most strongly
       associated with the receipt of drug therapy. When blacks were compared
       with whites, the adjusted relative odds were 0.59 (95 percent confidence
       interval, 0.38 to 0.93) for the receipt of an antiretroviral agent and
       0.27 (95 percent confidence interval, 0.13 to 0.56) for the receipt of
       PCP prophylaxis. CONCLUSIONS. Among patients infected with HIV, blacks
       were significantly less likely than whites to have received
       antiretroviral therapy or PCP prophylaxis when they were first referred
       to an HIV clinic. This disparity suggests a need for culturally specific
       interventions to ensure uniform access to care, including drug therapy,
       and uniform standards of care.
 DE    Adult  Antiviral Agents/*THERAPEUTIC USE  Asian Americans/STATISTICS &
       NUMER DATA  AIDS-Related Opportunistic Infections/PREVENTION & CONTROL
       Baltimore  Blacks/*STATISTICS & NUMER DATA  Confidence Intervals  Drug
       Utilization/*STATISTICS & NUMER DATA  Female  Health Services
       Accessibility  Hispanic Americans/STATISTICS & NUMER DATA  Human  HIV
       Infections/*DRUG THERAPY/*ETHNOLOGY  Logistic Models  Male  Physician's
       Practice Patterns/*STATISTICS & NUMER DATA  Pneumonia, Pneumocystis
       carinii/PREVENTION & CONTROL  Socioeconomic Factors  Support, Non-U.S.
       Gov't  Support, U.S. Gov't, P.H.S.  Urban Population  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).