Many HIV+ May Not Take Life-Saving Drugs: Study

An analysis of HIV-infected patients who died at one Texas hospital in 1999-2000 found that more than half of them were not taking highly active antiretroviral therapy. "I was really startled to see that so many patients were not on HIV therapy in an era when it's supposed to be widespread, and access is there," said the study's lead author, Dr. Mamta K. Jain of the University of Texas Southwestern Medical Center-Dallas. The full report, "Changes in Mortality Related to Human Immunodeficiency Virus Infection: Comparative Analysis of Inpatient Deaths in 1995 and in 1999-2000," was published in the journal Clinical Infectious Diseases (2003;36(8):1030-1038).

The researchers compared HIV-positive patients who died in 1995 (before HAART availability) to those who died in 1999-2000. They also assessed whether or not patients in the later group were taking HAART. Jain's team evaluated 200 HIV/AIDS patients -- 112 who died in 1995 and 88 who died in 1999-2000.

Despite "widespread availability" of HAART, only 48 percent of patients who died in 1999-2000 were taking HAART at the time of death, the authors reported. The main reasons the patients were not taking the drugs were an inability to adhere to the treatment regimen and an HIV diagnosis less than six months prior to death. Other reasons included an inability to tolerate the drugs due to underlying liver disease, the study indicates.

Another finding of the study is that many HIV-infected individuals not receiving HAART were minorities. Nine out of 12 patients who were diagnosed with HIV shortly before death, and 12 of 18 patients who did not take HAART as prescribed, were black or Hispanic, the authors wrote.

The team did see a decline in the number of people dying due to HIV. However, AIDS-defining illnesses, such as Pneumocystis carinii pneumonia, were still an important cause of death in patients not taking HAART, according to the report.

"I don't want to paint a gloomy picture," Jain said. "Definitely, the number of cases of patients dying with AIDS has decreased radically. But we were expecting to see a change in the types of diseases people were dying from, and we didn't see that. I think this study is important because, if you look at the HIV/AIDS literature, you see these dramatic changes, and people are living longer ... but I think we kind of lose sight of the fact that there are still areas in the country that still are seeing a lot of the same problems that we did prior to HAART being available."

Last year, CDC estimated that up to one-third of the nation's 850,000-950,000 HIV-positive people do not appear to be receiving treatment.

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