Prevalence and Predictors of Highly Active Antiretroviral Therapy Use in Patients With HIV Infection in the United States

Abstract

The proportion of persons under HIV care in the United States who had ever received HAART increased to over 70% of the affected population by January 1998 and the disparities in use between groups narrowed but did not disappear. However, nearly half of those eligible for HAART according to the U.S. Department of Health and Human Services guidelines were not actually receiving it nearly 2 years after these medications were first introduced. Strategies to promote the initiation and continuation of HAART are needed for those without contraindications and those who can tolerate it.

Effect of race and/or ethnicity in use of antiretrovirals and prophylaxis for opportunistic infection: a review of the literature

“…Nevertheless, only 53% were "currently" using HAART at the time of this second follow-up interview. 54 In comparison, by 1998 fully 87% of the MACS participants reported having ever used antiretroviral therapy, 81% reported "current" use of any antiretrovirals, and only 63% reported "current" use of potent antiretroviral therapy (HAART). 52 Among 764 Johns Hopkins AIDS Service patients (interviewed in 1998-1999) with a CD4 nadir Ͻ500 cells/mm 3 and peak HIV RNA Ͼ30,000 copies/ml, 93% reported having ever used antiretrovirals, 76% reported having ever used HAART, and 48% reported current use of HAART.…”

“…(See Table 1.) Overall, 15 studies had data collection periods that included 1996 or later, [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] i.e., after FDA approval for use of the first protease inhibitor in late 1995. Ten of the these reports specifically measured the use of either protease inhibitors, NNRTIs, or HAART.…”

“…Ten of the these reports specifically measured the use of either protease inhibitors, NNRTIs, or HAART. [45][46][47][48]50,[53][54][55][56][57] Overall, 14 studies found a negative association between non-white race and antiretroviral use in one or more multivariate analyses. 32,36-39,45-48,52-55 Among these 14, eight studies found only a negative association across all outcomes assessed, 32,[36][37][38][39]45,55,56 and six studies found mixed results depending on the specific outcome measure.…”

“…32,36-39,45-48,52-55 Among these 14, eight studies found only a negative association across all outcomes assessed, 32,[36][37][38][39]45,55,56 and six studies found mixed results depending on the specific outcome measure. 37,45,48,[52][53][54] Three studies found a positive association with at least one antiretroviral use measure, 40,44,48 two of which found either no association 44 or a negative association 48 across a different measure of antiretroviral use. Sixteen studies found no association between race/ethnicity and at least one measure of antiretroviral use; [33][34][35]37,[41][42][43][44][45][49][50][51][52][53][54]57 however, five of these also found a negative association on at least one antiretroviral use measure, 37,45,52-54 and one also found a positive association.…”

“…44 In four of these studies an association between race/ethnicity and antiretroviral use explicitly noted in bivariate analyses lost statistical significance after adjustment for other covariates. 49,50,53,54 Negative association with use of antiretrovirals (n = 14 studies). In all 14 of these studies, people whose race/ ethnicity was other than white had a lower likelihood than white study participants of receipt of antiretrovirals after adjustment for potential confounders (such as insurance status, income, and disease stage) in multivariate models.…”