Many Gay Men Infected With HIV Are Opting To Delay Treatment, Despite Availability Of Drugs

July 01, 1998

Geneva, Switzerland -- HIV-infected gay men in the United States who want drug therapy for HIV are generally able to get it, but not all of them are immediately jumping on the drug bandwagon, according to a study by University of California San Francisco AIDS researchers.

Many men may be cautiously waiting to see how their disease progresses before committing to a lifetime of a difficult drug regimen, said Ron Stall, PhD, MPH, a research scientist with the UCSF Center for AIDS Prevention Studies and the UCSF AIDS Research Institute.

Stall presented the study findings here today (July 1) at the 12th World AIDS Conference.

Research results showed 56 percent of 500 randomly selected HIV-infected men surveyed in New York, Los Angeles, Chicago, and San Francisco--the cities with the largest gay communities in the United States--were using multiple-drug therapy consisting of a protease inhibitor in combination with other anti-retroviral drugs. The study found no major differences in the rates among the cities.

"What I found surprising was the inability to detect differences based on income or ethnicity," Stall said. "All were in the range of 50 to 60 percent taking combination therapy. This tells me that even low-income gay men can get drugs if they push the system."

One significant finding was the link between individuals using combination therapy and those with advanced HIV infection. The study showed that CD4 T cell counts--which are lower in the later stages of infection because the virus enters these immune cells and kills them--were a very good predictor of who would be on combination therapy, according to Stall. Findings showed 80 percent of persons with CD4 T cell counts of less than 200 were following combination therapy, while only 40 percent of those with counts of more than 500 were on therapy.

Men with counts above 500 may feel like they are doing fine, Stall concluded. "Many are quite aware what their options are and they have decided to keep their own counsel," he said. "Gay men are an independent group, quite capable of making their own decisions regarding treatment options."

"The good news is that many individuals may be thinking about treatment options and are making up their own minds," he added.

"My guess is that these men are seriously looking at these recommendations, talking to their friends and doctors, and making informed choices," he said. "They're also aware that once they start drug therapy, they can never stop. Someone not prepared to make that commitment is better off delaying therapy than following it inconsistently, possibly creating resistant strains. From an adherence standpoint, it is probably better if someone who's not sure waits to begin therapy."

The study, led by UCSF associate professor of medicine Joseph Catania, PhD, is the first random household-based probability sample of gay men in multiple cities. The findings are based on men in the community and not restricted to a clinical sample of those who seek medical care. The study involved a random phone survey to more than 80,000 numbers. About 2,900 phone respondents identified themselves as gay men, and of these, about 500 said they were HIV-positive.

In the phone survey, the researchers asked about HIV and about broader issues important to gay men's health, such as gay community involvement, substance abuse, violence, social interactions, medical care, and relationships. Study collaborators from UCSF CAPS are Lance Pollack, PhD, senior statistician; Jay Paul, PhD, clinical psychologist; Diane Binson, PhD, assistant research sociologist; and Tom Mills, MD, researcher.

The UCSF ARI is an institute without walls that encompasses all UCSF AIDS programs under a single umbrella. Thomas Coates, PhD, is the director. The UCSF ARI includes a dozen research institutes, a wide range of clinical, behavioral science, and policy programs, and nearly 1,000 investigators.

University of California - San Francisco

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