FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 330:763-768 March 17, 1994 Number 11 Next

	Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

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 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.

Source Information

From the Johns Hopkins University School of Medicine, 1830 E. Monument St., Rm. 8059, Baltimore, MD 21205, where reprint requests should be addressed to Dr. Moore.

Full Text of this Article

Related Letters:

Racial Differences in the Use of Drug Therapy for HIV Disease
Simon P. A., Sorvillo F. J., Lapin R. K., Moore R. D., Chaisson R. E.
Extract | Full Text  
N Engl J Med 1994; 331:333-334, Aug 4, 1994. Correspondence

This article has been cited by other articles:

• Ogbuanu, I. U., Torres, M. E., Kettinger, L., Albrecht, H., Duffus, W. A. (2009). Epidemiological Characterization of Individuals With Newly Reported HIV Infection: South Carolina, 2004-2005. Am. J. Public Health 99: S111-S117 [Abstract] [Full Text]  
• Miranda, J., McGuire, T. G., Williams, D. R., Wang, P. (2008). Mental Health in the Context of Health Disparities. Am. J. Psychiatry 165: 1102-1108 [Full Text]  
• Chamberlain, J. M., Joseph, J. G., Patel, K. M., Pollack, M. M. (2007). Differences in Severity-Adjusted Pediatric Hospitalization Rates Are Associated With Race/Ethnicity. Pediatrics 119: e1319-e1324 [Abstract] [Full Text]  
• Wang, J., Noel, J. M., Zuckerman, I. H., Miller, N. A., Shaya, F. T., Mullins, C. D. (2006). Disparities in Access to Essential New Prescription Drugs between Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanic Whites. Med Care Res Rev 63: 742-763 [Abstract]  
• Landon, B. E., Wilson, I. B., McInnes, K., Landrum, M. B., Hirschhorn, L., Marsden, P. V., Gustafson, D., Cleary, P. D. (2004). Effects of a Quality Improvement Collaborative on the Outcome of Care of Patients with HIV Infection: The EQHIV Study. ANN INTERN MED 140: 887-896 [Abstract] [Full Text]  
• Cargill, V. A., Stone, V. E., Robinson, M. R. (2004). HIV Treatment in African Americans: Challenges and Opportunities. Journal of Black Psychology 30: 24-39 [Abstract]  
• Higgins, R. S.D. (2003). Understanding disparities in outcomes in cardiovascular medicine and thoracic oncology in African-American patients. Ann. Thorac. Surg. 76: S1346-1347 [Full Text]  
• Fryer, G. E. Jr, Green, L. A., Dovey, S. M., Yawn, B. P., Phillips, R. L., Lanier, D. (2003). Variation in the Ecology of Medical Care. Ann Fam Med 1: 81-89 [Abstract] [Full Text]  
• Christian, M. C., Trimble, E. L. (2003). Increasing Participation of Physicians and Patients from Underrepresented Racial and Ethnic Groups in National Cancer Institute-sponsored Clinical Trials. Cancer Epidemiol. Biomarkers Prev. 12: 277S-283 [Full Text]  
• Shi, L., Forrest, C. B., von Schrader, S., Ng, J. (2003). Vulnerability and the Patient-Practitioner Relationship: The Roles of Gatekeeping and Primary Care Performance. Am. J. Public Health 93: 138-144 [Abstract] [Full Text]  
• Sulkowski, M. S., Moore, R. D., Mehta, S. H., Chaisson, R. E., Thomas, D. L. (2002). Hepatitis C and Progression of HIV Disease. JAMA 288: 199-206 [Abstract] [Full Text]  
• Keruly, J. C., Conviser, R., Moore, R. D. (2002). Association of Medical Insurance and Other Factors With Receipt of Antiretroviral Therapy. Am. J. Public Health 92: 852-857 [Abstract] [Full Text]  
• Zimmerman, R. K., Mieczkowski, T. A., Wilson, S. A. (2002). Immunization Rates and Beliefs among Elderly Patients of Inner City Neighborhood Health Centers. Health Promot Pract 3: 197-206 [Abstract]  
• Shavers, V. L., Brown, M. L. (2002). Racial and Ethnic Disparities in the Receipt of Cancer Treatment. JNCI J Natl Cancer Inst 94: 334-357 [Abstract] [Full Text]  
• (2002). Policy Statements Adopted by the Governing Council of the American Public Health Association, October 24, 2001. Am. J. Public Health 92: 451-483 [Full Text]  
• Cook, J. A., Cohen, M. H., Grey, D., Kirstein, L., Burke, J., Anastos, K., Palacio, H., Richardson, J., Wilson, T. E., Young, M. (2002). Use of Highly Active Antiretroviral Therapy in a Cohort of HIV-Seropositive Women. Am. J. Public Health 92: 82-87 [Abstract] [Full Text]  
• Sambamoorthi, U., Moynihan, P. J., McSpiritt, E., Crystal, S. (2001). Use of Protease Inhibitors and Non-Nucleoside Reverse Transcriptase Inhibitors Among Medicaid Beneficiaries With AIDS. Am. J. Public Health 91: 1474-1481 [Abstract] [Full Text]  
• Jha, A. K., Shlipak, M. G., Hosmer, W., Frances, C. D., Browner, W. S. (2001). Racial Differences in Mortality Among Men Hospitalized in the Veterans Affairs Health Care System. JAMA 285: 297-303 [Abstract] [Full Text]  
• Mayberry, R. M., Mili, F., Ofili, E. (2000). Racial and Ethnic Differences in Access to Medical Care. Med Care Res Rev 57: 108-145 [Abstract]  
• Doescher, M. P., Saver, B. G., Franks, P., Fiscella, K. (2000). Racial and Ethnic Disparities in Perceptions of Physician Style and Trust. Arch Fam Med 9: 1156-1163 [Abstract] [Full Text]  
• Moore, L. J. (2000). Psychiatric Contributions to Understanding Racism. Transcultural Psychiatry 37: 147-183 [Abstract]  
• Fiscella, K., Franks, P., Gold, M. R., Clancy, C. M. (2000). Inequality in Quality: Addressing Socioeconomic, Racial, and Ethnic Disparities in Health Care. JAMA 283: 2579-2584 [Abstract] [Full Text]  
• Nuorti, J. P., Butler, J. C., Gelling, L., Kool, J. L., Reingold, A. L., Vugia, D. J. (2000). Epidemiologic Relation between HIV and Invasive Pneumococcal Disease in San Francisco County, California. ANN INTERN MED 132: 182-190 [Abstract] [Full Text]  
• Sulkowski, M. S., Thomas, D. L., Chaisson, R. E., Moore, R. D. (2000). Hepatotoxicity Associated With Antiretroviral Therapy in Adults Infected With Human Immunodeficiency Virus and the Role of Hepatitis C or B Virus Infection. JAMA 283: 74-80 [Abstract] [Full Text]  
• Eisenberg, L. (1999). Whatever Happened to the Faculty on the Way to the Agora?. Arch Intern Med 159: 2251-2256 [Full Text]  
• Shapiro, M. F., Morton, S. C., McCaffrey, D. F., Senterfitt, J. W., Fleishman, J. A., Perlman, J. F., Athey, L. A., Keesey, J. W., Goldman, D. P., Berry, S. H., Bozzette, S. A., Additional Authors From the HCSUS Consortium, (1999). Variations in the Care of HIV-Infected Adults in the United States: Results From the HIV Cost and Services Utilization Study. JAMA 281: 2305-2315 [Abstract] [Full Text]  
• Celentano, D. D., Vlahov, D., Cohn, S., Shadle, V. M., Obasanjo, O., Moore, R. D. (1998). Self-reported Antiretroviral Therapy in Injection Drug Users. JAMA 280: 544-546 [Abstract] [Full Text]  
• Strathdee, S. A., Palepu, A., Cornelisse, P. G. A., Yip, B., O'Shaughnessy, M. V., Montaner, J. S. G., Schechter, M. T., Hogg, R. S. (1998). Barriers to Use of Free Antiretroviral Therapy in Injection Drug Users. JAMA 280: 547-549 [Abstract] [Full Text]  
• Rosenheck, R., Seibyl, C. L. (1998). Participation and Outcome in a Residential Treatment and Work Therapy Program for Addictive Disorders: The Effects of Race. Am. J. Psychiatry 155: 1029-1034 [Abstract] [Full Text]  
• Fournier, A. M., Carmichael, C. (1998). Socioeconomic Influences on the Transmission of Human Immunodeficiency Virus Infection: The Hidden Risk. Arch Fam Med 7: 214-217 [Abstract] [Full Text]  
• LeBlanc, A. J., Mullan, J. T., Wardlaw, L. A., Harrington, C., Chang, S. W. (1998). Community-based service use by people with AIDS: the relevance of informal caregivers. Health (London) 2: 135-156 [Abstract]  
• Bangsberg, D., Tulsky, J. P., Hecht, F. M., Moss, A. R. (1997). Protease Inhibitors in the Homeless. JAMA 278: 63-65 [Abstract]  
• Laraque, F., Greene, A., Triano-Davis, J. W., Altman, R., Lin-Greenberg, A. (1996). Effect of Comprehensive Intervention Program on Survival of Patients With Human Immunodeficiency Virus Infection. Arch Intern Med 156: 169-176 [Abstract]  
• Hogg, R. S., Craib, K., Montaner, J. S.G., Schechter, M. T., Turner, B. J., Markson, L. E., Fanning, T. R., Chaisson, R. E., Moore, R. D. (1996). Race, Sex, Drug Use, and Human Immunodeficiency Virus Disease. NEJM 334: 123-124 [Full Text]  
• Selik, R. M., Chu, S. Y., Ward, J. W. (1995). Trends in Infectious Diseases and Cancers among Persons Dying of HIV Infection in the United States from 1987 to 1992. ANN INTERN MED 123: 933-936 [Abstract] [Full Text]  
• Moore, R. D., Keruly, J. C., Chaisson, R. E. (1995). Neutropenia and Bacterial Infection in Acquired Immunodeficiency Syndrome. Arch Intern Med 155: 1965-1970 [Abstract]  
• Chaisson, R. E., Keruly, J. C., Moore, R. D. (1995). Race, Sex, Drug Use, and Progression of Human Immunodeficiency Virus Disease. NEJM 333: 751-756 [Abstract] [Full Text]  
• Bennett, C. L., Homer, R. D., Weinstein, R. A., Dickinson, G. M., DeHovitz, J. A., Cohn, S. E., Kessler, H. A., Jacobson, J., Goetz, M. B., Simberkoff, M., Pitrak, D., George, W. L., Gilman, S. C., Shapiro, M. F. (1995). Racial Differences in Care Among Hospitalized Patients With Pneumocystis carinii Pneumonia in Chicago, New York, Los Angeles, Miami, and Raleigh-Durham. Arch Intern Med 155: 1586-1592 [Abstract]  
• Aaronson, K. D., Schwartz, J. S., Goin, J. E., Mancini, D. M. (1995). Sex Differences in Patient Acceptance of Cardiac Transplant Candidacy. Circulation 91: 2753-2761 [Abstract] [Full Text]  
• Simon, P. A., Sorvillo, F. J., Lapin, R. K., Moore, R. D., Chaisson, R. E. (1994). Racial Differences in the Use of Drug Therapy for HIV Disease. NEJM 331: 333-334 [Full Text]  
• (1994). ARE BLACKS WITH HIV TREATED LESS AGGRESSIVELY?. JWatch General 1994: 1-1 [Full Text]