Date: 21 Apr 2009

Antiretroviral Therapy and Communities of Color

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Abstract

The current HIV treatment guidelines from both the DHHS and IAS indicate that the best choices for first-line therapy include either efavirenz (EFV) or a ritonavir-boosted protease inhibitor combined with a fixed dose combination nucleoside backbone (Table 1).1,2 These recommendations have evolved from a long list of clinical trials, which have shown these regimens to be very effective in suppressing HIV replication and allowing immune preservation/restoration in both the short and long term. There is little in the published literature to suggest that the treatment of choice for treatment-naïve patients should be determined by the patient’s race or ethnic background. Several studies have examined the effect of race on treatment outcome with mixed results. Some studies have demonstrated that blacks (and in some cases Hispanics) have lower treatment response rates than whites while others have suggested comparable outcomes given comparable treatment access. This chapter will discuss the recommendations for initial therapy in HIV-infected individuals, review the literature on disparities in treatment response to HIV therapies, and discuss possible contributing factors that drive these disparities.