469. Use of Opportunistic Infection (OI) Prophylaxis between Blacks and Whites with HIV/AIDS
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
  • (Oramasionwu CU) 2011 IDSA Poster (FINAL).pdf (798.3 kB)
  • Background: Blacks are more affected by HIV/AIDS than any other race in the U.S. This study assessed if race was associated with use of OI (PCP and MAC) prophylaxis and compared use of OI prophylaxis while incorporating the monthly cost of therapy to determine if use of more costly medications differed by race.

    Methods: Data were from the 1996-2008 National Hospital Ambulatory Medical Care Surveys (NHAMCS). Survey weights were incorporated to generate national estimates. Visits primarily related to HIV/AIDS for Blacks and Whites were included. Visits for patients ages <15 years and of non-Black/non-White race were excluded. Use of prophylaxis encompassed at least one PCP medication (TMP-SMX, dapsone, pentamidine, or atovaquone) or at least one MAC medication (azithromycin, clarithromycin, or rifabutin). Visits that were associated with active infection (PCP or MAC) were excluded from the respective prophylaxis definitions.

    Results: ~9.1 million hospital ambulatory visits were identified. After controlling for confounders, the odds of PCP prophylaxis use were 16% higher for Blacks than for Whites (OR=1.16, 95% CI, 1.15-1.17). Other risk factors included male gender, age 30-49 years, location in the Western and Southern region, metropolitan statistical area location, and Medicare coverage. In a separate regression analysis, the odds of MAC prophylaxis use were 12% higher for Blacks than for Whites (OR=1.12, 95% CI, 1.10-1.13). Other risk factors included male gender, age 30-49 years, location in the Western and Southern region, and Medicaid and Medicare coverage. Use of more costly OI medications (atovaquone, pentamidine, and rifabutin) was noted to be greater in visits documenting private insurance as compared to visits that lacked insurance. Of note, fewer Blacks than Whites had private insurance, while more Blacks than Whites were uninsured (p<0.001).

    Conclusion: These findings suggest that more Blacks with HIV/AIDS use OI prophylaxis. Health insurance coverage influenced the antibiotics selected for prophylaxis. The factors contributing to these race-based differences require further investigation to determine the contribution of differential HIV/AIDS treatment access versus regional consistency with national guidelines.

    Subject Category: H. HIV/AIDS and other retroviruses

    Christine Oramasionwu, PharmD, MSc, PhD1,2, Kenneth Lawson, PhD1, Carolyn Brown, PhD1, Gene Morse, PharmD3, Jim Koeller, MS1,2 and Christopher R. Frei, PharmD, MSc1,2, (1)The University of Texas at Austin, College of Pharmacy, Austin, TX, (2)The University of Texas Health Science Center San Antonio, San Antonio, TX, (3)University at Buffalo, SUNY, Buffalo, NY


    C. Oramasionwu, None

    K. Lawson, None

    C. Brown, None

    G. Morse, None

    J. Koeller, None

    C. R. Frei, AstraZeneca: Investigator, Research grant
    Forest: Scientific Advisor, Consulting fee
    OrthoMcNeil Janssen: Consultant, Investigator and Scientific Advisor, Consulting fee and Research grant
    Pfizer: Investigator, Research grant
    NIH/NCRR: Investigator, Research grant and UL1 RR025767

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