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Treatment of AIDS has become both more effective and more costly with recent development of antiretroviral drug therapies such as protease inhibitors and nonnucleoside analog reverse transcriptase inhibitors. These drugs have been found to suppress replication of the human immunodeficiency virus (HIV) that causes AIDS, increase production of CD4 cells that bolster the immune system, reduce morbidity, and prolong survival among HIV-infected people.
Unfortunately, women are less likely than men to receive these life-prolonging therapies, according to a study of Florida Medicaid data. States need to investigate this disparity in use of antiretroviral drug therapies and develop policies to foster better access of women to these treatments, conclude Kathryn H. Anderson, Ph.D., of Vanderbilt University, and Jean M. Mitchell, Ph.D., of Georgetown University.
In a study supported by the Agency for Healthcare Research and Quality (HS09560), they analyzed Florida Medicaid eligibility, enrollment, and claims data for people living with HIV or AIDS (PLWHAs) from 1993 through 1997. They used the claims data to identify patients who received two nucleoside analogs (TWONUKES) or one protease inhibitor and a nucleoside combination (PI+NUKES) and constructed the probability of dying from eligibility and enrollment data. The probabilities of receiving TWONUKES and PI+NUKES were 0.16 and 0.09, respectively, lower for women relative to men. Blacks were more likely to receive TWONUKES than whites, but the reverse was true for Hispanics (0.04 higher probability for blacks and 0.03 lower probability for Hispanics compared with whites). In contrast, blacks were significantly less likely to receive PI+NUKES.
Both drugs had significant negative effects on the probability of death. PLWHAs who received PI+NUKES were 60 percent as likely to die each month as those who did not receive this combination therapy. The receipt of TWONUKES lowered patients' relative hazard of death by close to 66 percent each month compared with patients who did not receive the drugs. Despite lower use of antiretroviral therapies, women were only 56 percent as likely to die as men. The survival of women with AIDS could be improved even more if their access to antiretroviral therapy was equal to that of men.
More details are in "Differential access in the receipt of antiretroviral drugs for the treatment of AIDS and its implications for survival," by Drs. Anderson and Mitchell, in the November 13, 2000 Archives of Internal Medicine 160, pp. 3114-3120.
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