QUALITY OF CARE, NOT DEMOGRAPHICS DETERMINES AIDS SURVIVAL

September 13, 1995
Media Contact: Marc Kusintz
Phone: (410) 955-8665
E-mail: mkusinitz@welchlink.welch.jhu.edu

Access to good medical care is more important than sex, race, injection-drug use or socioeconomic status in determining how soon individuals infected with HIV will develop AIDS, and how long they will survive, according to a study by researchers at The Johns Hopkins Medical Institutions.

The Hopkins finding contradicts several previous studies suggesting that demographic factors, such as sex and race, may determine how well a person responds to treatment for HIV infection or AIDS. The results were published in the September 21 issue of The New England Journal of Medicine.

"The study convincingly shows that demographics factors don't determine the course of HIV infection and AIDS," says Richard E. Chaisson, M.D., associate professor of medicine and director of the Hopkins AIDS Service. "Here at Johns Hopkins we have shown that by providing equivalent, high-quality care to patients from demographic groups, we can ensure that no one is at a disadvantage regarding how soon they develop AIDS and how long they survive."

The study included 1,372 HIV-positive patients who were receiving ongoing care at Johns Hopkins. Thirty percent of the patients were women, 77 percent were black, and 21 percent were white. At the start of the study, 740 of the patients had not yet developed AIDS.

During the study, 427 of the 1,372 patients died (31 percent). The researchers reported that there were no signficant differences in survival rates among demographic groups. There were also no differences in survival according to the type of health insurance carried by patients, whether they were still using injection drugs, housing status (homeless versus not homeless), or level of education.

Regardless of demographic factors, patients were more likely to die if the level of immune system cells called CD4 lymphocytes was below 200 (the normal level is about 1,000) or if they had symptoms of AIDS at the beginning of the study.

People who took AZT or received preventive therapy for Pneumocystis pneumonia, a disease that commonly strikes people with AIDS, tended to live longer than those who did not receive such treatment.

However, those patients who had already taken AZT before they enrolled in the Hopkins clinic did not survive as long as those who began the drug after enrolling in the study.

"This difference reflects the fact that AZT's beneficial effect is time-limited," says Chaisson. "So those who began AZT therapy at the start of our study had more time during the study to benefit from the drug."

"AZT benefits patients only for a year or two," says Chaisson. "Patients who had begun taking AZT before they entered our study had already enjoyed the benefits of the drug for some time. Those who began AZT therapy at the start of our study had more time during the study to benefit from the drug."

The report also confirms a previously published finding by Hopkins researchers that showed HIV-infected blacks, women and injection-drug users referred to Hopkins for treatment were significantly less likely than white males to have already received appropriate treatment for HIV. About 75 percent of HIV-infected patients cared for by Hopkins are black, Chaisson says.

"One reason we can offer such excellent care for our patients is that we have significant financial support from the Ryan White Act and other private and public programs," Chaisson adds.

The Ryan White Act is a federal funding program for AIDS care named after a boy who died of the disease after receiving an HIV-tainted blood transfusion.

"These programs are critically important for guaranteeing state-of-the-art medical care for all Americans with HIV," Chaisson says.

Other authors of the report include Jeanne C. Keruly, B.S.N. and Richard D. Moore, M.D.

The work was supported by a grant from the Agency for Health Care Policy and Research.


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