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February 16, 2000

Access to Antiretroviral Therapy

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(7):883-884. doi:10.1001/jama.283.7.882

To the Editor: Dr Shapiro and colleagues1 have provided the most comprehensive review of HIV care in the United States. They noted that "disenfranchised groups in the United States are less likely to receive medications for HIV that are potentially lifesaving. . . ." Among all patients, 85% who satisfied the criteria for treatment with antiretroviral agents according to the guidelines of the Department of Health and Human Services received either a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor. For January 1998, the frequency of this treatment exceeded 90% for those with private insurance and was about 80% for those with no insurance. These differences are statistically significant and should be disturbing, but there is another way to look at these data. It is unlikely that there is any other major group of patients in the United States in which 80% do not have insurance but nevertheless have access to drugs that cost more than $10,000 per year. For that matter, there are probably few diseases where guidelines for management show this type of compliance. Estimates for compliance with the National Cholesterol Education Program, for example, is reported to be 22% to 29%.