title: Factors associated with changes in the use of antiretroviral therapy by a cohort of homosexual men infected with human immunodeficiency virus type 1.
abstract: Changes in the use of antiretroviral drugs and factors associated with changes from monotherapy with zidovudine (ZDV) to other regimens were quantified in the Multicenter AIDS Cohort Study. Participants who had been receiving monotherapy with ZDV were categorized as (1) discontinuing ZDV monotherapy; (2) switching to disanosine (ddI), zalcitabine (ddC), or stavudine (d4T) monotherapy; (3) switching to combination therapy (ZDV with ddI, ddC, or d4T); or (4) continuing ZDV monotherapy. From 1990 to 1994, the percentage of participants using ZDV monotherapy decreased from 27% to 17% (among participants without AIDS) and from 60% to 17% (among those with AIDS). At the same time, the proportion of participants using combination therapy increased from zero to 8% (no AIDS) and from 8% to 26% (AIDS). Polychotomous logistic regression methods were used to identify the factors predicting changes from ZDV monotherapy. Among participants without AIDS, indicators of drug failure (such as a lower CD4 lymphocyte count or symptoms of human immunodeficiency virus type 1 infection) were predictive of the initiation of combination therapy, while among patients with AIDS they were predictive of a switch to an alternative monotherapy. A decrease in hemoglobin levels, a marker of ZDV toxicity, was predictive for all patients of a switch to other monotherapy. These data show that clinicians and patients are opting for more aggressive antiretroviral regiments and that changes in CD4 lymphocyte count and in the status of symptoms remain the primary guides for changes in therapy.
authors.affiliation: Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: L P
authors.initials: LP
authors.lastname: Park
authors.forename: N M
authors.initials: NM
authors.lastname: Graham
authors.forename: L P
authors.initials: LP
authors.lastname: Jacobson
authors.forename: R
authors.initials: R
authors.lastname: Murphy
authors.forename: D
authors.initials: D
authors.lastname: Besley
authors.forename: S
authors.initials: S
authors.lastname: Zucconi
authors.forename: A
authors.initials: A
authors.lastname: Muñoz
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D016049:Didanosine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006454:Hemoglobins / Q000378:metabolism; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D018119:Stavudine / Q000627:therapeutic use; D016047:Zalcitabine / Q000627:therapeutic use; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D006454:Hemoglobins; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine; D016047:Zalcitabine; D018119:Stavudine; D016049:Didanosine