Intravenous drug use, relationship with providers, and stage of HIV disease influence the prescription rates of protease inhibitors

Objective: To assess rates of prescriptions of protease inhibitors (PI) and determinants of not being prescribed PIs in a cohort of EW-infected people eligible (according to published guidelines) for highly active antiretrovi ral therapy (HAART). Design: Cross-sectional survey. Methods: A total of 684 patients with CD4(+) counts <500 cells/mu l were en rolled from seven Italian HIV treatment centers from October 1997 to April 1998. A questionnaire on health-related quality of life (MOS-HIV) and patie nt ratings of the quality of care was administered. Sociodemographic variab les, HIV disease-related factors, and prescribed antiretroviral therapy wer e also recorded. Results: 61% of those enrolled were prescribed PI (median, 7.5 months). In addition, 75% of patients had previously received antiretroviral therapy. F ewer than 1% were prescribed nonnucleoside reverse transcriptase inhibitors (NNRTIs). Using multivariable logistic regression considering those with C D4(+) counts <500 cells/mu l, patients reporting the least information rece ived (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.23-2.58), inje cting drug users (IDUs; OR, 1.73; 95% CI, 1.18-2.54), people with CD4(+) co unts >200 cells/mu l (OR, 1.76; 95% CI, 1.19-2.61), and patients with early stage disease (OR, 2.24; 95% CI, 1.73-2.90) were less likely to have be pr escribed PIs. Conclusions: Of patients eligible for HAART, only 61% were prescribed PIs. People who wanted more information, IDUs, and patients in earlier disease s tages are significantly less likely to be prescribed PIs. Access to HAART r emains a critical issue in the management of HN disease.