title: Therapy naivete in the era of potent antiretroviral therapy.
abstract: Antiretroviral therapy (ART) use was examined in a cohort of homosexual men infected with HIV-1 for long periods. Multivariate logistic regression models, stratified by clinical indication (below and above 500 CD4 cells/microl or prior AIDS), were used to determine predictors of ART naivete. Of the 673 men seen at visit 28 (10/97-4/98), 89 (13.2%) never used ART and 548 (81.4%) were current users; 55% of the therapy-naive were ART eligible. Lower CD4 cell counts predicted (P <.001) ART use. Determinants of therapy naivete differed by clinical indication. African-American race and no prior ambulatory visit predicted (P <.05) ART naivete in men with > or =500 CD4 cells/microl. Among those with clinical indications, less education, younger age, multiple sexual partners, and no prior ambulatory visit significantly predicted ART naivete. In this era of effective ART, use was not universal. Besides disease markers, these nonclinical determinants need to be considered for promoting population therapy effectiveness.
authors.affiliation: Department of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA.
authors.forename: L P
authors.initials: LP
authors.lastname: Jacobson
authors.forename: M E
authors.initials: ME
authors.lastname: Gore
authors.forename: S A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: J P
authors.initials: JP
authors.lastname: Phair
authors.forename: S
authors.initials: S
authors.lastname: Riddler
authors.forename: R
authors.initials: R
authors.lastname: Detels
mesh_terms: D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001727:Bisexuality / Q000523:psychology*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004522:Educational Status; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology*; D015497:HIV-1; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009042:Motivation; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012307:Risk Factors; D012747:Sexual Partners; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D014504:Urban Health
chemical_list: D019380:Anti-HIV Agents