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Many Inner-City HIV Patients Not on HAART
  By David Douglas
NEW YORK (Reuters Health) Dec 26 - The majority of HIV patients admitted to a Chicago hospital in recent years were not receiving highly active antiretroviral therapy (HAART) and had drug abuse and other problems, researchers report in the November issue of AIDS Patient Care.
As lead investigator Dr. Joseph J. Pulvirenti told Reuters Health, "despite the availability of effective HIV therapy, many HIV patients in the US--especially in the inner city--are still in the 1980s."
Dr. Pulvirenti of Cook County Hospital, Chicago, and colleagues analyzed 2736 admissions of 1562 HIV-infected patients to that institution over period of about 3 years, ending in July of 2002.
Of all such admissions, 43% were related to non-HIV infectious diseases, 36% were HIV-related and 25% were related to internal medicine diagnoses. The most common HIV-related problem was candidiasis (13%). Pulmonary afflictions were the most common of other problems (40%).
Most patients were black (81%), male (72%) and 74% were active substance abusers. Only 48% with a previous HIV diagnosis were taking HAART, and of these, only 37% had a viral load less than 1000 copies per mL.
In patients with CD4 counts of less than 200 cells per mL, those not taking HAART were more likely to be black (83% versus 76%), homeless (13% versus 5%), active substance abusers (79% versus 65%), female (28% versus 22%) and new to the hospital system (19% versus 6%).
The researchers point out that aggressive programs are needed "to address substance abuse issues and to improve patient use of HAART."
"We have shown," Dr. Pulvirenti concluded, "that concern about HIV in some of our patients is trumped by substance abuse, poverty, and homelessness."
AIDS Patient Care and STDs 2003;17:565-573.
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