Access and effectiveness of protease inhibitors in a field setting
Description
The purpose of this study was to examine possible barriers to protease inhibitor therapy and to evaluate the effectiveness of protease inhibitor therapy in a field setting. A retrospective period cross-sectional study of HIV-infected individuals who received care from an HIV outpatient clinic between January 1996 and July 1998 was conducted. Logistic regression was used to determine socio-demographic and clinical characteristics associated with both receiving and responding to protease inhibitor therapy Of the 1874 individuals who were eligible for protease inhibitor therapy, 1004 (53.5%) had received protease inhibitor therapy. Individuals who received protease inhibitor therapy were more likely to be men (OR 1.38, [1.09--1.77]), less likely to be African-American (OR 1.86, [1.48--2.33]), less likely to have a history of substance use (OR 1.42, [1.15--1.76]), less likely to have a history of incarceration (OR 1.44, [1.00--2.07]), more likely to have attended the clinic within the past six months (OR 6.66, [4.98--8.92]), more likely to have a baseline CD4+ count below 200 cells/dl (OR 2.16, [1.74--2.70]), and more likely to have been diagnosed with an opportunistic process (OR 2.12, [1.68--2.69]) Of the 458 individuals who had received protease inhibitor therapy and had at least two viral load measurements, 200 (43.7%) experienced at least a one-log drop in viral load. Individuals who experienced at least a one-log drop in viral load were more likely to have a history of substance use (OR 1.65, [1.06--2-55]), more likely to have less than six months of antiretroviral therapy prior to initiating protease inhibitor therapy (OR 1.84, [1.16--2.92]), and less likely to have experience with more than one protease inhibitor (OR 2.02, [1.28--3.21]). In addition, in comparison to individuals who had a low baseline viral load, individuals who had a medium or high baseline viral load were more likely to experience a one-log drop in viral load (OR medium: 6.98, [4.14--11.79], OR high: 14.09, [7.49--26.50]) The results from this study indicate that there are barriers to receiving protease inhibitor therapy in a field setting. Additionally, this study demonstrates that not all individuals who receive protease inhibitor therapy experience at least a one-log drop in viral load