Prevalence and predictors of highly active antiretroviral therapy use in patients with HIV infection in the United States

Background: Highly active antiretroviral therapy (HAART) became standard fo r HIV in 1996, Studies at that time showed that most people infected with H IV had initiated HAART, but that members of minority groups and poor people had lower HAART use. It is not known whether high levels of HAART use have been sustained or whether socioeconomic and racial disparities have dimini shed over time. Objectives: To determine the proportion of patients who had received and we re receiving HAART by January 1998, and to evaluate predictors of HAART rec eipt. Design and Participants: Prospective cohort study of a national probability sample of 2267 adults receiving HIV care who completed baseline, first fol low-up, and second follow-up interviews from January 1996 to January 1998. Main outcome variables: Proportion currently using HAART at second follow-u p (August 1997 to January 1998), contrasted with the cumulative proportions using HAART at any time before January 1998 and before December 1996. Anal yses: Bivariate and multiple logistic regression analysis of population cha racteristics predicting current use of HAART at the time of the second foll ow-up interview. Results: The proportion of patients ever having received HAART increased fr om 37% in December 1996 to 71% by January 1998, but only 53% of people were receiving HAART at the time of the second follow-up interview. Differences between sociodemographic groups in ever using HAART narrowed after 1996, I n bivariate analysis, several groups remained significantly less likely to be using HAART at the time of the second follow-up interview: blacks, male and female drug users, female heterosexuals, people with less education, th ose uninsured and insured by Medicaid, those in the Northeast, and those wi th CD4 counts of greater than or equal to 500 cells/mul (all p < .05). Usin g multiple logistic regression analysis, low CD4 count (for CD4 <50 cells/m ul: odds ratio [OR], 3.20; p < .001) remained a significant predictor of cu rrent HAART use at the time of the second follow-up interview, but lack of insurance (OR, 0.71; p < .05) predicted not receiving HAART. Conclusions: The proportion of persons under HIV care in the United States who had ever received HAART increased to over 70% of the affected populatio n by January 1998 and the disparities in use between groups narrowed but di d not disappear. However, nearly half of those eligible for HAART according to the U.S. Department of Health and Human Services guidelines were not ac tually receiving it nearly 2 years after these medications were first intro duced. Strategies to promote the initiation and continuation of HAART are n eeded for those without contraindications and those who can tolerate it.