Evaluating HIV/AIDS Disparities for Blacks in the United States: A Review of Antiretroviral and Mortality Studies by ProQuest

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Evaluating HIV/AIDS Disparities for Blacks in the
United States: A Review of Antiretroviral and
Mortality Studies
Christine U. Oramasionwu, PharmD, MSc, BCPS; Carolyn M. Brown, PhD; Kenneth A. Lawson, PhD;
Laurajo Ryan, PharmD, MSc, BCPS, CDE; Christopher R. Frei, PharmD, MSc, BCPS



                                                                               tor (NRTI), zidovudine.1 The novel concept of triple
  Funding/Support: Funding for this project was provided in                    combination therapy was later introduced in the mid-
  part by the National Institutes of Health loan repayment pro-                1990s with the introduction of 2 new classes of antiret-
  gram and a graduate fellowship from The University of Texas                  rovirals—protease inhibitors (PIs) and nonnucleoside
  at Austin, both granted to Dr Oramasionwu. This project was                  reverse transcriptase inhibitors (NNRTIs).2 National
  also supported by faculty start-up funds from The University                 consensus guidelines have been in place since 1996 to
  of Texas at Austin, awarded to Dr Frei.                                      aid clinicians in developing appropriate antiretrovi-
  The purpose of this systematic review was to identify stud-                  ral regimens.3 The Department of Health and Human
  ies that evaluated HIV/AIDS disparities by examining differ-                 Services guidelines recommend the use of at least 3
  ences in the receipt of antiretroviral therapy and differences               active medications from at least 2 different drug class-
  in mortality between blacks and whites in the United States.                 es for both treatment-naive and treatment-experienced
  The authors conducted 2 Web-based literature searches of                     patients.4 This combination of antiretrovirals is known
  the MEDLINE database for published peer reviewed scien-                      as highly-active antiretroviral therapy (HAART). Since
  tific articles that analyzed black race as a predictor of anti-              its introduction, HAART has dramatically changed the
  retroviral therapy and mortality. Five reports met the criteria              clinical course of HIV/AIDS infection and has been
  for the antiretroviral literature search, whereas seven reports              associated with improved outcomes for patients.2,5
  met the criteria for the mortality literature search. After eval-                It has been hypothesized that underutilization of
  uating individual study results, it appears the evidence to                  antiretrovirals by blacks may explain the difference in
  identify racial differences in the receipt of antiretroviral ther-           mortality seen in national surveillance data.6,7 Blacks
  apy as well as the evidence to document disparities in mor-                  have been shown to experience poorer health outcomes
  tality is either limited or mixed. Further research is needed to             compared to whites in the general US population.8-10
  support or refute the hypothesis that there are inequalities                 Similar disparities in outcomes, particularly mortality,
  for blacks with HIV/AIDS.                                                    have also been demonstrated in the HIV/AIDS popula-
                                                                               tion.11 Blacks with HIV/AIDS have been shown to be
  Keywords: HIV/AIDS n race/ethnicity n health disparities                     disproportionately represented among HIV/AIDS-
  n mortality                                                                  related hospitalizations according to an analysis of hos-
                                                                               pitalization records from California, Florida, New Jer-
  J Natl Med Assoc. 2009;101:1221-1229
                                                                               sey, New York, South Carolina, and Washington.12
                                                                               Blacks represented the highest rates of hospitalizations
Author Affiliations: The University of Texas at Austin, College of Pharmacy,
Austin, Texas (Drs Oramasionwu, Brown, Ryan, Lawson, and Frei); and The        (51%) of any race and were hospitalized 0.5 days longer
University of Texas Health Science Center at San Antonio, Department of        than whites.12 HAART has greatly reduced HIV/AIDS-
Medicine, San Antonio, Texas (Drs Oramasionwu, Ryan, and Frei).                related morbidity and mortality, yet the rates of decline
Corresponding Author: Christine U. Oramasionwu, PharmD, MSc, BCPS, The         have not been equal between blacks and whites, a dis-
University of Texas Health Science Center at San Antonio, Pharmacother-
                                                                               parity that has been documented as early as the
apy Education and Research Center, MSC-6220, 7703 Floyd Curl Dr, San
Antonio, TX 78229-3900 (chrorams@mail.utexas.edu).                             1980s.11,13,14 National data suggest this racial gap may, in
                                                                               fact, be widening even after HAART became available
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