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Giordano Thomas P.; White, Clinton A. Jr; Sajja, Prasuna; Graviss, Edward A.; Arduino, Roberto C.; Adu-Oppong, Ahmed; Lahart, Christopher J.; Visnegarwala, Fehmida
JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1st, 2003

Ethnic minority, female, and drug-using patients may be less likely to receive highly active antiretroviral therapy (HAART), despite its proven benefits. We reviewed the medical records of a consecutive population of 354 patients entering care in 1998 at the Thomas Street Clinic, an academically affiliated, public, HIV-specialty clinic in Houston, to determine the factors associated with not receiving HAART as recorded in pharmacy records. Ninety-two patients (26.0%) did not receive HAART during at least 6 months of follow-up. Patients who did not receive HAART were more likely to be women and to have missed more than two physician appointments and were less likely to have a CD4 count <200 cells/μL or a viral load ≥105 copies/mL. In multivariate logistic analysis, missed appointments (OR = 5.85, p < .0001), female sex (OR = 2.53, p = .001), and CD4 count ≥200 cells/μL (OR = 2.50, p = .001) were independent predictors of not receiving HAART. More than half the patients who never received HAART never returned to the clinic after their first appointment. Among patients new to care, women and those with poor appointment adherence were less likely to receive HAART. Efforts to improve clinic retention and further study of the barriers to HAART use in women are needed.

Presented in part at the First IAS Conference on HIV Pathogenesis and Treatment, Buenos Aires, July 2001.

Thomas P. Giordano received support from NIH grant 5 T32 AI07456-10 and in part from the resources and the use of facilities at the Houston Center for Quality of Care and Utilization Studies, Houston Veterans Affairs Medical Center.

Address correspondence and reprint requests to Fehmida Visnegarwala, Thomas Street Clinic, Room 424, 2015 Thomas Street, Houston, TX 77009 U.S.A.; e-mail:

Manuscript received February 6, 2002: accepted October 21, 2002.

© 2003 Lippincott Williams & Wilkins, Inc.