Minority Gain in Early Use of AZT Questioned : Disease: Some doubt the study’s validity. It also shows a better result for non-white AIDS patients than for whites when both got later treatment.

In an unexpected finding, a Department of Veterans Affairs study released Thursday suggests that minorities infected with the AIDS virus may not benefit to the same extent as whites from early use of the antiviral drug AZT.

Results from the study, presented to a Food and Drug Administration advisory committee, indicated that early use of AZT helped whites, but the evidence appeared “neutral or favoring late AZT treatment in minority patients,” the department said.

Department officials, AIDS researchers and other experts, however, urged caution in interpreting the data, saying that further studies are needed to determine whether the racial distinctions are valid and to understand why they occurred.

The FDA’s antiviral drugs advisory committee declined to recommend a change in current medical thinking, which calls for early AZT therapy in patients who are infected with the human immunodeficiency virus and whose immune systems show specific signs of damage.

A separate study released Thursday concluded that white males who have health insurance are far more likely to receive AZT treatments than other HIV-infected patients, including women, minorities, drug users and uninsured patients.

The study, conducted by Brown University and published in the Journal of General Internal Medicine, suggests that doctors may be withholding AZT from many patients based on perceptions of their ability to pay and willingness to adhere to a rigorous treatment program.

The Department of Veterans Affairs study compared early use of AZT with later therapy in patients who had initial symptoms of disease but who had not yet reached the stage of fully developed AIDS.

Although whites and minorities appeared to benefit from the drug, minorities who took it at an early stage fared no better than those who received it much later, the study indicated.

Overall, 21% of the patients in the early treatment group developed AIDS or died, contrasted with 26% in the later treatment group, indicating that early therapy is helpful in slowing the progression of the disease.

Among whites, 20% of patients in early treatment developed AIDS or died, contrasted with 28% in the later treatment group, mirroring the overall findings.

Among minorities, however, early and late treatment produced similar results, suggesting that minorities received less benefit from treatment at an early stage.

In the minority group, which included blacks and Latinos, 22% in early treatment developed AIDS or died, compared to 22% of those receiving later treatment.

Some AIDS researchers suggested that the study methodology was flawed because it was not intended to examine racial differences and because it was changed several times after the research had begun.

Some researchers also questioned whether the overall numbers of patients studied were large enough to allow them to draw meaningful conclusions about the racial differences.

Researchers were at a loss to account for the differences, although several possibilities were raised. Some suggested that the two groups might not have been comparable in health status at the start of the study because minorities often do not have the same access to medical care as whites. In addition, the VA said minorities who participated in the study had been somewhat less rigorous than whites in taking the drug.

Dr. Paul Volberding, a Colorado AIDS researcher who conducted one of two major federally sponsored studies on early use of AZT, said the VA study “just doesn’t fit with anything else we’ve seen,” noting that his study did not indicate that early AZT use was more effective among whites.

“If there had been a striking lack of benefit in minorities, we should have seen something--and didn’t,” he said. Even so, he said, “you can’t ignore a result like this.”

Volberding said, however, that he was concerned about the potential impact of the findings on the treatment of HIV-infected minority patients. “My own strong bias is that we shouldn’t change anything based on this,” he said.

Paul Kawata, executive director of the National Minority AIDS Council, expressed similar concern. “We must not send people of color with HIV infection underground,” he said. “This study has the potential to take away hope for HIV-infected minorities. It is much too early to draw any definitive conclusions.”