Despite more widespread prescribing of antiretroviral therapy for HIV infection, disparities remain
Although prescription of antiretroviral therapy (ART) to combat HIV disease became more widespread from 2002 to 2008, patients who were female, black, or younger still had lower ART rates than male, white, or older patients, reveals a new study. John A. Fleishman, Ph.D., of the Agency for Healthcare Research and Quality (AHRQ), and colleagues analyzed data from the medical records at 13 U.S. sites participating in the Human Immunodeficiency Virus Research Network. They assessed ART prescribing for 14,092 patients for each year they were in care. They examined ART use as a function of sex, race/ethnicity, HIV risk group, age, and CD4 history (CD4 cell counts are an indicator of HIV disease progression).
The proportion of HIV-infected patients prescribed ART increased from 60 percent in 2002 to 80 percent in 2008. Among those with two or more CD4 tests of 350 cells/mm3 or less, the proportion increased from 82 percent in 2002 to 92 percent in 2008. ART rates were higher for those with lower CD4 counts (more advanced disease), but increased over time for all CD4 groups. While ART prescribing rates rose among all demographic groups, racial/ethnic and sex disparities persisted. For example, ART rates were consistently lower for women than men, and blacks were less likely to be prescribed ART than whites, after adjusting for CD4 history. ART use increased for all age groups, but more slowly for the youngest group (18–29 years vs. 30–39 and 50 and older), and these differences were more pronounced at earlier disease stages. The fact that ART use increased among traditionally disadvantaged groups, such as women and black patients, is encouraging and shows that improvements in care are possible for such groups, note the researchers.
More details are in "Disparities in receipt of antiretroviral therapy among HIV-infected adults (2002–2008)," by Dr. Fleishman, Baligh R. Yehia, M.D., Richard D. Moore, and others in the May 2012 Medical Care 50(5), pp. 419-427. Reprints (AHRQ Publication No. 12-R065) are available from the AHRQ Publications Clearinghouse.
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