PROPHYLAXIS FOR OPPORTUNISTIC INFECTIONS AMONG HIV-INFECTED PATIENTS RECEIVING MEDICAL-CARE

In 1995 and 1997, the United Stales Public Health Service (USPHS) and the Infectious Disease Society of America (IDSA) published recommendat ions for primary prophylaxis of Pneumocystis carinii pneumonia (PCP), Mycobacterium avium complex (MAC), and toxoplasmosis in HIV-infected a dults. We evaluated their implementation at four hospital-based HIV cl inics in New York City in patients who initially met the CD4(+) criter ion for prophylaxis between January, 1995 and April: 1997. Medical rec ords were reviewed at 6-month intervals to determine drugs prescribed. We identified 149 patients for the PCP sample, 130 for MAC, and 138 f or toxoplasmosis. In the three samples, 91% were black and Hispanic, 7 5% to 81% were male, and 43% to 47% had a history of injection drug us e (IDU); median age was between 39 and 40 years. PCP prophylaxis was p rescribed during 93% of intervals and did not vary significantly by cl inic or patient characteristics. Over the study period, MAC prophylaxi s increased from 22% to 62%, and prescriptions for macrolides increase d from 38% to 87% of all prescriptions. In the logistic regression ana lysis, prescription for MAC prophylaxis at any time during the study p eriod was less likely in blacks compared with whites (odds ratio [OR] = .08; 95% confidence interval [CI] = .01, .52) and patients attending the clinic with the lowest rate of MAC prophylaxis (clinic D) compare d with the clinic with the highest rate (clinic B; OR = .04; 95% CI = .01,.26). Toxoplasmosis prophylaxis was prescribed in 73% of intervals and did not differ significantly by antibody status (p = .42). Prescr ibing patterns were uniform across gender, HIV risk behavior, and age for PCP and MAC prophylaxis but differed by clinic and race for MAC pr ophylaxis. Trends in prophylaxis for opportunistic illnesses must cont inue to be monitored in light of the success of antiretroviral therapy in reducing the morbidity and mortality associated with HIV/AIDS.