The care of HIV-infected adults in the United States

Background and Methods In order to elucidate the medical care of patients w ith human immunodeficiency virus (HIV) infection in the United States, we r andomly sampled HIV-infected adults receiving medical care in the contiguou s United States at a facility other than a military, prison, or emergency d epartment facility during the first two months of 1996. We interviewed 76 p ercent of 4042 patients selected from among the patients receiving care fro m 145 providers in 28 metropolitan areas and 51 providers in 25 rural areas . Results During the first two months of 1996, an estimated 231,400 HIV-infec ted adults (95 percent confidence interval, 162,800 to 300,000) received ca re. Fifty-nine percent had the acquired immunodeficiency syndrome according to the case definition of the Centers for Disease Control and Prevention, and 91 percent had CD4+ cell counts of less than 500 per cubic millimeter. Eleven percent were 50 years of age or older, 23 percent were women, 33 per cent were black, and 49 percent were men who had had sex with men. Forty-si x percent had incomes of less than $10,000 per year, 68 percent had public health insurance or no insurance, and 30 percent received care at teaching institutions. The estimated annual direct expenditures for the care of the patients seen during the first two months of 1996 were $5.1 billion; the ex penditures for the estimated 335,000 HIV-infected adults seen at least as o ften as every six months were $6.7 billion, which is about $20,000 per pati ent per year. Conclusions In this national survey we found that most HIV-infected adults who were receiving medical care had advanced disease. The patient populatio n was disproportionately male, black, and poor. Many Americans with diagnos ed or undiagnosed HIV infection are not receiving medical care at least as often as every six months. The total cost of medical care for HIV-infected Americans accounts for less than 1 percent of all direct personal health ex penditures in the United States. (N Engl J Med 1998;339:1897-904.) (C) 1998 , Massachusetts Medical Society.