Factors associated with changes in the use of antiretroviral therapy by a cohort of homosexual men infected with human immunodeficiency virus type 1

Lawrence P. Park*, Neil M.H. Graham, Lisa P. Jacobson, Robert Murphy, David Besley, Sharon Zucconi, Alvaro Muñoz

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Changes in the use of antiretroviral drugs and factors associated with changes from monotherapy with zidovudine (ZDV) to other regimens were quantified in the Multicenter AIDS Cohort Study. Participants who had been receiving monotherapy with ZDV were categorized as (1) discontinuing ZDV monotherapy; (2) switching to didanosine (ddI), zalcitabine (ddC), or stavudine (d4T) monotherapy; (3) switching to combination therapy (ZDV with ddI, ddC, or d4T); or (4) continuing ZDV monotherapy. From 1990 to 1994, the percentage of participants using ZDV monotherapy decreased from 27% to 17% (among participants without AIDS) and from 60% to 17% (among those with AIDS). At the same time, the proportion of participants using combination therapy increased from zero to 11% (no AIDS) and from 2% to 21% (AIDS), and the proportion switching to a different monotherapy increased from zero to 8% (no AIDS) and from 8% to 26% (AIDS). Polychotomous logistic regression methods were used to identify the factors predicting changes from ZDV monotherapy. Among participants without AIDS, indicators of drug failure (such as a lower CD4 lymphocyte count or symptoms of human immunodeficiency virus type 1 infection) were predictive of the initiation of combination therapy, while among patients with AIDS they were predictive of a switch to an alternative monotherapy. A decrease in hemoglobin levels, a marker of ZDV toxicity, was predictive for all patients of a switch to other monotherapy. In addition, private health insurance coverage was associated with reduced odds of the discontinuation of antiretroviral therapy. These data show that clinicians and patients are opting for more aggressive antiretroviral regimens and that changes in CD4 lymphocyte count and in the status of symptoms remain the primary guides for changes in therapy.

Original languageEnglish (US)
Pages (from-to)930-937
Number of pages8
JournalClinical Infectious Diseases
Volume21
Issue number4
DOIs
StatePublished - Oct 1995

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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