This study of zidovudine treatment and racial differences in outcome among patients with advanced HIV disease revealed the following:

Patient Characteristics

Laboratory characteristics at enrollment suggested a less favorable clinical status for blacks and Hispanic patients than for whites—particularly in that the former were more likely to have advanced HIV disease at the initiation of zidovudine therapy. However, there were no significant racial/ethnic differences in the mean total white blood cell count or neutrophil count

Survival and Development of Opportunistic Infections

Overall, white patients had the most favorable and black patients the least favorable outcome:
• Survival rates at 1 and 2 years for white, black, and Hispanic patients with AIDS were 79% and 40%; 69% and 27%; and 63% and 39%, respectively.
• Black patients with AIDS were markedly more likely to develop serious opportunistic infectious and, in particular, to develop PCP.
• Black patients with AIDS were notably less likely than other patients to receive PCP prophylaxis, at both enrollment (37% of whites, 23% of blacks, and 54% of Hispanic) and during follow-up (75% of whites, 66% of blacks, and 68% of Hispanics). After adjusting for differences across centers, there were no racial differences because “those centers with the lowest and the highest use of PCP prophylaxis tended to be those centers with, respectively, the highest or lowest representation of black participants.”
• “Adjustment for risk group status [i.e. iv drug users] had a minimal effect on the observed racial differences in survival or on the risk of development of opportunistic infections.”

Zidovudine Dosage

• There were no significant differences between the black, white or Hispanic patients who received continuous zidovudine therapy, however “white patients overall received zidovudine for a significantly greater median proportion of their follow-up time (0.87; range, 0.04 to 1.0) compared with black (0.83; range 0.02 to 1.0) and Hispanic (0.81; range, 0.02 to 1.0) patients.”
• Although there were no statistically significant differences in the median time between diagnosis and treatment according to race-ethnicity, “there was a tendency for white patients to be treated slightly earlier than other patients.”

In response to these findings, the authors recommend, “Innovative approaches are needed to ensure more widespread use of and earlier access to zidovudine therapy and PCP prophylaxis, particularly in the black and Hispanic communities”