Use of therapeutic and prophylactic drugs for AIDS by homosexual and bisexual men in three US cities

Abstract

Objective To determine the use of AIDS drugs and therapies by populations with relatively good access to health care. Design Prospective cohort study, with interview and examination twice a year since 1988. Setting Two public-health departments (San Francisco Department of Health and Denver Disease Control Service) and a private clinic (Howard Brown Memorial Clinic, Chicago). Participants HIV-seropositive homosexual and bisexual men in San Francisco (311 men), Denver (120 men) and Chicago (59 men). Interventions HIV counseling and testing at each visit. Main outcome measures Time and duration of use of drugs used for AIDS and Pneumocystis carinii pneumonia (PCP) treatment and prophylaxis. Results Zidovudine and pentamidine use increased from 1987 through 1989 in all three cities. In San Francisco in 1987, only 17 out of 110 (15%) HIV-seropositive men without AIDS reported taking zidovudine. By 1990, over 90% of AIDS patients and approximately 80% of HIV-seropositive men with low CD4+ cell counts (< 200 χ 10⁶/l had taken zidovudine; most men who by 1990 had never taken zidovudine (82%) or PCP prophylaxis (95%) had not been recommended these therapies because they did not have symptoms and their absolute CD4+ cell counts were >200 χ 10⁶/l. However, overall in the three cities, only 68% of the AIDS patients and 63% of the men with low CD4 + cell counts had taken zidovudine for more than 6 months by 1990. Most men who had stopped taking zidovudine (67%) did so because of toxicity; however, 64% of respondents gave reasons other than drug toxicity as a or the sole reason why they discontinued zidovudine. Conclusions AIDS therapeutic and prophylactic drugs were increasingly (and appropriately) recommended to and accepted by these cohorts after 1987, but had limited consistent use because of toxicity, adverse side-effects, and several other less readily appreciated reasons. These data do not indicate that zidovudine use in San Francisco would mainly account for the observed slowing in the rate of increase of AIDS cases in homosexual and bisexual men in this city after 1987.