ACCESS TO THERAPY IN THE MULTICENTER AIDS COHORT STUDY, 1989-1992

The study aims were (i) to describe secular trends in the utilization of antiretrovirals, antivirals, Pneumocystis carinii pneumonia (PCP) p rophylaxis, and antifungal prophylaxis and (ii) to determine whether f actors such as clinical status, health services utilization, insurance status, income, education and race were associated with access to the rapy. Data on utilization of therapy, health services utilization, inc ome and insurance status were collected semiannually from October 1990 through March 1992 from 1415 homosexual/bisexual HIV-1 seropositive m en in the Multicenter AIDS Cohort Study (MACS). Prevalence of therapy use according to level of immunosuppression was determined at each stu dy visit. Clinical AIDS was defined using the 1987 CDC definition. Fac tors associated with use of antiretroviral therapy and PCP prophylaxis were assessed using multiple logistic regression with robust variance techniques to adjust variance estimates and significance levels for w ithin-person correlations of drug use over time. Prevalence of zidovud ine use remained relatively constant throughout the study period. In c ontrast, use of didanosine (21-34%), acyclovir (23-34%) and dideoxycyt idine (zalcitabine) (8-25%) increased in participants with clinical AI DS. Similar trends were seen for combination antiretroviral therapy, t rimethoprim-sulfamethoxazole, dapsone, ketoconazole and fluconazole. H owever, reported use of aerosolized pentamidine fell. After adjusting for CD4+ lymphocyte count and HIV-1 symptoms, previous HIV-related hos pitalization (OR = 1.52; 95% CI = 1.22-1.91), outpatient visit (OR = 2 .83; 95% CI = 2.12-3.78), having insurance (OR = 1.32; 95% CI = 1.01-1 .75), college education (OR = 1.42; 95% CI = 1.13-1.80) and white race (OR = 1.58; 95% CI = 1.21-2.07) were all associated with being on ant iretroviral therapy in persons without clinical AIDS. In persons with clinical AIDS, having insurance (OR = 2.89; 95% CI = 1.04-8.02) and a previous outpatient visit (OR = 11.69; 95% CI = 1.77-77.30) were the s ignificant variables. Factors significantly associated with being on P CP prophylaxis in multivariate models were previous hospitalization, p revious outpatient visit, and college education (for subjects without clinical AIDS).