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

Objective. The authors performed a systematic and critical review of published studies investigating potential associations between race and/or ethnicity and use of HIV-related medications, including antiretroviral medications and medications used for prophylaxis of opportunistic infections. Methods. The authors conducted a Web-based search of the University of California MEDLINE/HealthSTAR database for articles published from January 1, 1985, to October 31, 2001. References cited in articles were used to identify potential additional articles for this review. The authors reviewed articles published in peer-reviewed scientific journals that analyzed race/ethnicity as a predictor of antiretroviral or HIV-related prophylactic medication use. Results. The authors identified 28 reports, including: (a) 26 studies published in 1991-2001 that addressed antiretroviral use, spanning data collection periods from 1984 to 1999; (b) 11 studies published in 1994-2001 that addressed prophylaxis for Pneumocystis carinii pneumonia (PCP), reporting on data collected from 1989 to 1998; and (c) three studies published from 1998 to 2001 that addressed prophylaxis for other opportunistic infections, reporting on data collected from 1993 to 1998. Among the studies that addressed antiretroviral use, 14 found a negative association between non-white race and at least one measure of antiretroviral use, three studies found a positive association, and 16 studies found no association; seven studies found mixed results across several measures of antiretroviral use. Only four of 11 studies found a negative association between race/ethnicity and PCP prophylaxis; the remainder found no association. Two out of three studies found a negative association between race/ethnicity and prophylaxis for other infections. Conclusions. There is evidence of racial/ethnic disparities in utilization of antiretrovirals, which are known to be strongly associated with positive HIV health outcomes. It is now imperative for researchers and policy makers to better understand the causes of these disparities, evaluate programs that affect the delivery of HIV medications, and implement program and policy changes necessary to address the disparities.