Predictors of use of highly active antiretroviral therapy (HAART) among persons with AIDS in San Francisco, 1996-1999

Highly active antiretroviral therapy (HAART) has contributed to a decrease in AIDS-related morbidity and mortality. This study used population-based A IDS surveillance data to evaluate the prevalence and predictors of HAART us e among persons with AIDS in San Francisco. Use of HAART among persons livi ng with AIDS increased from 41% in 1996 to 72% in 1999. Fourteen percent of persons diagnosed with AIDS between 1996 and 1999 initiated HAART before t heir AIDS diagnosis. Use of HAART before an AIDS diagnosis increased from 5 % in 1996 to 26% in 1999. In the multivariable analysis, African Americans, injection drug users, and those without insurance at the time of AIDS diag nosis were less likely to use HAART before AIDS diagnosis. Delayed initiati on of HAART after AIDS was more likely to occur among African Americans, in jection drug users, homeless persons, those with public insurance, and thos e with higher CD4 counts. Although the overall prevalence of HAART use was high, disparity in use of HAART existed by race and risk group, patient's i nsurance status, and facility of diagnosis. Barriers in use of treatment sh ould be identified so all persons with AIDS can benefit from improved thera pies.