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July 2, 1997

Protease Inhibitors in the Homeless

Author Affiliations

From the Center for AIDS Prevention Studies, AIDS Research Institute (Drs Bangsberg and Moss), and the Departments of Medicine (Drs Hecht and Tulsky) and Epidemiology and Biostatistics (Dr Moss), University of California, San Francisco, and Medical Service (Dr Tulsky) and AIDS Program (Dr Hecht), San Francisco General Hospital.

JAMA. 1997;278(1):63-65. doi:10.1001/jama.1997.03550010077044

Homeless people are often thought not to adhere to therapy. Should we try to make protease inhibitors available to them? The new therapies for human immunodeficiency virus (HIV) infection are expensive, and their use may lead to the development of drug resistance. Do these drawbacks outweigh the ethical imperative to make effective drugs available to an underserved population?

In late 1995, the first protease inhibitor was licensed by the Food and Drug Administration for persons infected with HIV. In combination with reverse transcriptase inhibitors, protease inhibitors give unprecedented improvements in CD4+ cell count, viral load, morbidity, and mortality.1 One press report used the term "Lazarus effect"2 to describe the return to functional status of some patients with end-stage acquired immunodeficiency syndrome (AIDS). Driven by both science and enthusiasm, the standard of care for HIV-infected patients has quickly become combination antiretroviral therapy with a protease inhibitor.1,3 The price