Browsing Theses and Dissertations School of Pharmacy by Title "The role of sociodemographic variables on access to ganciclovir and foscarnet therapy for AIDS patients in the treatment of cytomegalovirus (CMV) retinitis"
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The role of sociodemographic variables on access to ganciclovir and foscarnet therapy for AIDS patients in the treatment of cytomegalovirus (CMV) retinitisA historical cohort study was conducted to assess the impact of sociodemographic and clinical variables, including age, gender, mode of transmission, race and socioeconomic status (SES), as defined by median income of zip code, on treatment and progression of CMV retinitis in Maryland AIDS patients. One hundred ninety four adult patients diagnosed with CMV retinitis (9/87-9/94) were followed from AIDS diagnosis to CMV retinitis diagnosis, then to death. Inpatient hospital medical records and a statewide automated AIDS database were the primary sources of data. Survival analyses with covariates were conducted to assess differences in survival according to sociodemographic strata. Chi-square analyses were conducted to assess differences in drug therapy, and Cox proportional-hazards regression was applied to assess predictors of survival time. Results of this study indicate that there is no difference by race or socioeconomic status (SES) in the treatment of, or survival time for CMV retinitis in this population. The median survival time from AIDS diagnosis to death was 619 days. The median time between AIDS diagnosis and CMV retinitis diagnosis was 352 days, and the median survival time from CMV retinitis diagnosis to death was 207 days. There was a significant difference in severity of CMV retinitis at first diagnosis by race. More black patients were diagnosed at the most severe stage, while more white patients were diagnosed at the earliest stage of CMV retinitis (Chi-Square, p =.024). The vast majority of patients (87%) were initiated on treatment within seven days of diagnosis regardless of race. There were no significant differences in time to treatment by race, sex, age, socioeconomic status, or severity of retinitis at diagnosis. The data from this study demonstrate that among AIDS patients with CMV retinitis, black patients are more likely to enter treatment and be diagnosed at a more severe stage of CMV retinitis than white patients. Among possible explanations for this finding is underlying disparities in access to medical care. However, once diagnosed, there is no difference in the treatment or outcome of this disease, as measured by the study variables.