Access to protease inhibitors among HIV -infected patients: Does patient adherence matter

Background. Current, national guidelines recommend that providers consider patient adherence in their decision to prescribe antiretroviral medications for HIV-infected individuals. We sought to determine whether this prescribing practice contributes to the existing disparities in treatment among minorities and other vulnerable populations.;Methods. In the HIV Cost and Services Utilization Study (HCSUS), we prospectively studied a nationally representative sample of HIV-infected patients and their providers in the U.S. We examined data for the subset of patients (n = 1890, 66% of original patient cohort) whose providers completed the physician survey (n = 398). We assessed whether providers agree that adherence is an important factor in their decision to prescribe protease inhibitors (More versus Less Restrictive), and whether this prescribing attitude is a moderating or intervening variable in the disparities in protease inhibitor use. We used multivariable parametric survival analysis to identify the association between providers' prescribing attitude and time until first protease inhibitor use.;Results. Most providers agreed that adherence is an important factor in their decision to prescribe protease inhibitors and that this More Restrictive attitude is associated with later use of protease inhibitors. This prescribing practice appears to contribute to later protease inhibitor use among women compared to men and among Latinos compared to Whites. A similar, but not statistically significant pattern was present among drug and alcohol users and the poor. This practice pattern does not appear to contribute to the disparities in protease inhibitor use between Blacks and Whites.;Conclusion. Delaying antiretroviral therapy for non-adherent HIV-infected patients, as recommended by current HIV guidelines, may contribute to the existing disparities in care, thus current HIV practices should be reconsidered.