Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons

Abstract

The authors conclude that traditionally disadvantaged groups have less access to AZT, the only antiretroviral agent demonstrated to increase survival of patients who have symptomatic HIV infection.

Effect of race and/or ethnicity in use of antiretrovirals and prophylaxis for opportunistic infection: a review of the literature

“…[45][46][47][48]50,[53][54][55][56][57] Overall, 14 studies found a negative association between non-white race and antiretroviral use in one or more multivariate analyses. 32,36-39,45-48,52-55 Among these 14, eight studies found only a negative association across all outcomes assessed, 32,[36][37][38][39]45,55,56 and six studies found mixed results depending on the specific outcome measure. 37,45,48,[52][53][54] Three studies found a positive association with at least one antiretroviral use measure, 40,44,48 two of which found either no association 44 or a negative association 48 across a different measure of antiretroviral use.…”

“…29 In a logistic regression model that adjusted for level of illness, injection drug use, gender, and insurance status, whites were more likely to report being offered AZT than non-whites (odds ratio [OR] = 1.73; 95% confidence interval [CI] 1.11, 2.69). 32 McLaughlin et al performed an analysis of data on 366 patients (age Ͼ12 years) with an index AIDS diagnosis in 1989-1991 (limited to AIDS patients who had continuous enrollment in New Jersey Medicaid before the AIDS diagnosis and who had not received any antiretrovirals or PCP prophylaxis during the year prior to an AIDS diagnosis). 37 After adjustment for age, injection drug use, gender, primary source of care, and year of AIDS diagnosis, non-whites were less likely to have had any Medicaid claim for AZT following the AIDS diagnosis than whites (OR = 0.76; 95% CI 0.5, 0.9).…”

“…30 The most significant change in these guidelines, however was the discussion about preliminary evidence that suggested providers might wish to discontinue PCP prophylaxis in patients who had achieved sustained (3-6 months) CD4 count elevations Ͼ200 in response to HAART. 32 …”

“…The possibility of this limitation is further supported by the fact that seven [33][34][35]41,43,50,51 out of the 12 studies that performed cross-sectional analyses [31][32][33][34][35]39,41,43,45,46,50,51,57 and five 33,34,43,50,57 out of seven studies with analytic sample sizes less than 350 33,34,43,45,52,57 found no association. In contrast, only three 42,49,57 out of 14 studies that performed longitudinal analyses, [36][37][38]40,42,44,[47][48][49][52][53][54][55]57 and five 35,…”

“…Among those studies that did identify an association between race/ethnicity and antiretroviral use, the overwhelming majority, 13 of 16, found a negative association, 32,[36][37][38][39][45][46][47][52][53][54][55][56] two found a positive association, 40,44 and one found both negative and positive associations. 48 Given the general trend in ethnic/racial disparities across a variety of illnesses, the finding of greater use of antiretrovirals among people of nonwhite race/ethnicity is an unexpected one.…”