MONDAY, April 12, 2004 (HealthDayNews) -- Most doctors considered gender, race and income when they decided whether to prescribe powerful drugs to AIDS patients in the late 1990s, new research suggests.
The doctors seemed to think that some groups were automatically less likely to take the drugs as directed, said study co-author Dr. Mitchell D. Wong.
"Latinos got treated later than whites, women got treated later than men, and people who were poor got treated later than those who were wealthy," said Wong, an assistant professor of medicine at the University of California, Los Angeles.
And, he added, treatment for blacks often was postponed regardless of whether the doctors were scrupulous about providing treatment to patients they didn't think would follow directions.
While Wong said the study doesn't confirm the existence of racism in doctors' offices, he thinks it does seem to show physicians are making assumptions based on race and other factors. "If our hypothesis is true, physicians are perceiving these patients as being less adherent" to a drug regimen, he said.
The findings appear in the April issue of the Journal of General Internal Medicine.
Although doctors first diagnosed AIDS cases in the United States in the early 1980s, effective treatments didn't appear until the mid-1990s. Drug companies began releasing a variety of drugs known as protease inhibitors, which allow many patients to lower levels of the AIDS virus in their blood.
Initially, doctors feared patients might become more sick if they couldn't follow strict, complicated drug regimens that pinpointed the exact times they needed to take the drugs, Wong said.
Although advances since then have made the drugs easier to take, doctors still worry about patients who don't take them as directed, he added. The risk is that the virus will use the brief respites from treatment to develop resistance and become immune to the drugs.
In the new study, Wong and his colleagues examined surveys of 1,717 AIDS patients and 367 doctors from 1996 to 1998.
Almost 90 percent of the doctors said adherence -- sticking to directions -- was an important factor in their prescription practices. Those doctors were more likely to delay treatment for women, Latinos and the poor.
Almost all the doctors, including those who didn't worry about adherence,
were more likely to delay treatment for blacks than for whites, the researchers found.
However, the research didn't show that any of the delays in treatment trimmed the life spans of patients.
Postponing treatment is not always a bad thing, said Dr. David Bangsberg, an associate professor of medicine at the University of California, San Francisco. It can make sense if patients need to be treated for depression or drug abuse, he added.
"The problem comes when therapy is delayed to the point where someone is severely ill or dies," he said. "There comes a point where you have to treat everybody."
Both Wong and Bangsberg said the next step is to help doctors make better decisions about starting and postponing treatment.
More information
To learn more about HIV/AIDS and treatments, visit the U.S. Centers for Disease Control and Prevention or the National Institute of Allergy and Infectious Diseases.
