Two Out Of Three With
Treatment Late


SEATTLE (Reuters Health) - A large number of people who are HIV-infected don't get treatment until the disease has already advanced, and heterosexuals, injection drug users and blacks and Hispanics appear to get treatment later than others who are infected with the virus that causes AIDS. The findings were reported here Monday at the 9th annual Retroviral Conference.
"We found that during the 5-year period (1996-2000), 33% patients began antiretroviral therapy (ART) early, 26% initiated ART at the generally recommended period, and 40% began treatment late," Dr. A. D. McNaghten, of the US Centers for Disease Control and Prevention (CDC), told Reuters Health.
Compared with whites, "Hispanics were 1.8 times more likely to initiate ART late, and blacks were about 1.7 times more likely to initiate ART late," she said.
When categorized by HIV risk factors, injection drug users and heterosexuals were more likely to delay the start of ART compared with non-drug users and homosexual men. On the other hand, females and individuals under the age of 25 years were less likely to get a late start compared with males and those older than 25 years.
McNaghten said it is not clear "if patients are testing for HIV late, or accessing care late, or both."
Also, "we don't know if patients are waiting to start therapy. Providers as well may be waiting to start therapy for some of the patients, since resistance is an issue," she continued. "Some patients and providers may be waiting until the CD4 level drops a little bit so they can maximize the benefits of antiretroviral therapy."
In the study, the researchers divided patients into three groups based on levels of CD4, the immune system cell attacked by HIV. Those who started treatment early had CD4 counts of 350 cells per microliter of blood or greater, those who started treatment at the generally recommended point had CD4 counts between 250 and 350 cells per microliter, and those who began treatment late had less than 250 CD4 cells per microliter or an AIDS-defining illness.
The information was obtained from patient charts in 100 clinics in 10 US cities, primarily urban areas. All of the 4,379 study participants were 13 years of age or older who were enrolled as patients in these clinics.
Commenting on the report, Dr. Harold Jaffe of the CDC said, "Two out of every five Americans with HIV begin treatment later than the point which is currently recommended in federal guidelines."
He added, "Late treatment is particularly a problem for the non-white population, for injecting drug users and for people infected heterosexually."
Jaffe stressed that "this may be the result of delayed diagnosis of their infection, delayed treatment, or both." Both epidemiologists agree the next step will be to answer these questions.
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