Skip to main content
Journal cover image

Racial and ethnic differences in outcome in zidovudine-treated patients with advanced HIV disease

Publication ,  Journal Article
Easterbrook, PJ; Keruly, JC; Creagh-Kirk, T; Richman, DD; Chaisson, RE; Moore, RD; Bartlett, J; Link, G; McAvinue, S; Bryson, Y; al, E
Published in: Journal of the American Medical Association
1991

Objectives. - To determine if racial-ethnic differences exist in survival, disease progression, and development of myelosuppression in zidovudine- treated patients with advanced human immunodeficiency virus (HIV) disease. Design. - Prospective observational study. Setting. - Hospital and private clinics in 12 metropolitan centers. Patients. - The study included 754 non- Hispanic white, 165 black, and 106 Hispanic patients with the acquired immunodeficiency syndrome (AIDS) or advanced AIDS-related complex (ARC) who received up to 2 years of zidovudine therapy. Outcome Measures. - Survival, development of Pneumocystis carinii pneumonia (PCP), other opportunistic infections, and myelosuppression. Results. - At initiation of zidovudine therapy, Hispanic and particularly black patients had more advanced HIV disease than white patients, as indicated by lower baseline CD4 + counts, hematocrits, and AIDS-defining diagnoses. Black patients with AIDS also had a worse prognosis compared with white and Hispanic patients with AIDS. The product-limit survival rates at 2 years for white, black, and Hispanic patients with AIDS were 40%, 27%, and 39%, respectively (black vs white, P=.01; Hispanic vs white, P=.32, by the log-rank test). The respective proportions of patients who developed PCP at 2 years were 46%, 66%, and 44% (black vs white, P=.0001; Hispanic vs white, P=.86) and for other opportunistic infections the proportions were 56%, 63%, and 63%, respectively (black vs white, P=.03; Hispanic vs white, P=.09). There were no significant racial-ethnic differences in survival or in the development of opportunistic infections for patients with ARC, and there were no differences in the incidence of myelosuppression or dose reduction or suspension for patients with either ARC or AIDS. After adjusting for more advanced HIV disease (mainly low CD4 + counts and hematocrits), black race was no longer a significant independent predictor of survival. Adjustment for racial differences in the use of PCP prophylaxis accounted for most of the excess risk for the development of PCP in black patients compared with white patients with AIDS. Conclusions. - Racial differences in survival and the development of opportunistic infections are mainly due to the more advanced HIV disease in black patients when zidovudine therapy is started and to their less frequent use of PCP prophylaxis. Innovative approaches are needed to ensure more widespread use of and earlier access to zidovudine therapy and PCP prophylaxis.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Journal of the American Medical Association

DOI

ISSN

0098-7484

Publication Date

1991

Volume

266

Issue

19

Start / End Page

2713 / 2718

Related Subject Headings

  • General & Internal Medicine
  • 11 Medical and Health Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Easterbrook, P. J., Keruly, J. C., Creagh-Kirk, T., Richman, D. D., Chaisson, R. E., Moore, R. D., … al, E. (1991). Racial and ethnic differences in outcome in zidovudine-treated patients with advanced HIV disease. Journal of the American Medical Association, 266(19), 2713–2718. https://doi.org/10.1001/jama.266.19.2713
Easterbrook, P. J., J. C. Keruly, T. Creagh-Kirk, D. D. Richman, R. E. Chaisson, R. D. Moore, J. Bartlett, et al. “Racial and ethnic differences in outcome in zidovudine-treated patients with advanced HIV disease.” Journal of the American Medical Association 266, no. 19 (1991): 2713–18. https://doi.org/10.1001/jama.266.19.2713.
Easterbrook PJ, Keruly JC, Creagh-Kirk T, Richman DD, Chaisson RE, Moore RD, et al. Racial and ethnic differences in outcome in zidovudine-treated patients with advanced HIV disease. Journal of the American Medical Association. 1991;266(19):2713–8.
Easterbrook, P. J., et al. “Racial and ethnic differences in outcome in zidovudine-treated patients with advanced HIV disease.” Journal of the American Medical Association, vol. 266, no. 19, 1991, pp. 2713–18. Scival, doi:10.1001/jama.266.19.2713.
Easterbrook PJ, Keruly JC, Creagh-Kirk T, Richman DD, Chaisson RE, Moore RD, Bartlett J, Link G, McAvinue S, Bryson Y, al E. Racial and ethnic differences in outcome in zidovudine-treated patients with advanced HIV disease. Journal of the American Medical Association. 1991;266(19):2713–2718.
Journal cover image

Published In

Journal of the American Medical Association

DOI

ISSN

0098-7484

Publication Date

1991

Volume

266

Issue

19

Start / End Page

2713 / 2718

Related Subject Headings

  • General & Internal Medicine
  • 11 Medical and Health Sciences