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HIV-infected patients with certain sociodemographic characteristics are less likely to take antiretroviral therapy

Guidelines have recommended life-prolonging antiretroviral therapy (ART) for people infected with the human immunodeficiency virus (HIV) that causes AIDS if they have less than 500 CD4 cells/Ál and/or more than 10,000 RNA copies/ml of blood. ART is optional for individuals with less viral burden (fewer RNA copies per ml of blood) and whose immune systems are more competent (CD4 count of 500 or more). However, HIV-infected people with clinical indications for ART who are less educated, younger, have multiple sexual partners, and do not use outpatient care are unlikely to be taking ART, according to a recent study. These nonclinical factors need to be considered when promoting population therapy effectiveness, conclude members of the Multicenter AIDS Cohort Study (MACS), which was jointly funded by the National Institute of Allergy and Infectious Diseases, the National Cancer Institute, and the Agency for Healthcare Research and Quality.

The researchers analyzed factors predicting ART use and non-ART use among a group of more than 650 homosexual and bisexual men (most of whom were white) participating in MACS, who were enrolled in 1984-1985 and in 1987-1991 and returned every 6 months for physical exams, surveys, neuropsychological screenings, lab workups, and other services. The researchers compared the clinical, insurance, sociodemographic, and risk-taking characteristics of individuals who never reported taking ART with those who did during the entire followup period (1984-1998).

Among men who never used ART, over half (55 percent) met the recommended clinical criteria for ART at that time. Among men with CD4 cell counts less than 500, those who had never received ART were more than twice as likely to have less than a college education and to have multiple sexual partners as those who took ART. Also, non-ART users were nearly nine times as likely not to have used outpatient health care services. The fact that less education, younger age, and having multiple sex partners were associated with not using ART among eligible patients suggests that those with a risk-taking profile may be less likely to use ART. Providers may have considered these risk-taking patients, who made little use of outpatient care, poor candidates for complying with complex therapy, which can lead to drug resistance.

More details are in "Therapy naivete in the era of potent antiretroviral therapy," by Lisa P. Jacobson, Mary E. Gore, Steffanie A. Strathdee, and others, in the February 2001 Journal of Clinical Epidemiology 54, pp. 149-156.

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