USE OF THERAPEUTIC AND PROPHYLACTIC DRUGS FOR AIDS BY HOMOSEXUAL AND BISEXUAL MEN IN 3 UNITED-STATES CITIES

Objective: To determine the use of AIDS drugs and therapies by populat ions with relatively good access to health care. Design: Prospective c ohort study, with interview and examination twice a year since 1988. S etting: Two public-health departments (San Francisco Department of Hea lth and Denver Disease Control Service) and a private clinic (Howard B rown Memorial Clinic, Chicago). Participants: HIV-seropositive homosex ual and bisexual men in San Francisco (311 men), Denver (120 men) and Chicago (59 men). Interventions: HIV counseling and testing at each vi sit. Main outcome measures: Time and duration of use of drugs used for AIDS and Pneumocystis carinii pneumonia (PCP) treatment and prophylax is. Results: Zidovudine and pentamidine use increased from 1987 throug h 1989 in all three cities. In San Francisco in 1987, only 17 out of 1 10 (15%) HIV-seropositive men without AIDS reported taking zidovudine. By 1990, over 90% of AIDS patients and approximately 80% of HIV-serop ositive men with low CD4+ cell counts (< 200 x 10(6)/l) had taken zido vudine; most men who by 1990 had never taken zidovudine (82%) or PCP p rophylaxis (95%) had not been recommended these therapies because they did not have symptoms and their absolute CD4+ cell counts were > 200 x 10(6)/l. However, overall in the three cities, only 68% of the AIDS patients and 63% of the men with low CD4+ cell counts had taken zidovu dine for more than 6 months by 1990. Most men who had stopped taking z idovudine (67%) did so because of toxicity; however, 64% of respondent s gave reasons other than drug toxicity as a or the sole reason why th ey discontinued zidovudine. Conclusions: AIDS therapeutic and prophyla ctic drugs were increasingly (and appropriately) recommended to and ac cepted by these cohorts after 1987, but had limited consistent use bec ause of toxicity, adverse side-effects, and several other less readily appreciated reasons. These data do not indicate that zidovudine use i n San Francisco would mainly account for the observed slowing in the r ate of increase of AIDS cases in homosexual and bisexual men in this c ity after 1987.