Even when anti-HIV medication is available free of charge, substantial numbers of HIV-positive people die without ever access HIV therapy, according to research conducted in British Columbia and published in the October 15th edition of the Journal of Infectious Diseases. Native Americans, women, and people on low incomes were significantly less likely to have accessed anti-HIV therapy before death. Furthermore, even if anti-HIV treatments were used before death, investigators found that women and people on a low income were at significantly increased risk of taking treatment less than 75% of the time, a well established risk-factor for poor outcome.
In north America there are concerns about inequitable access to HAART. Research has shown that racial minorities, women, the poor and drug users are less likely to access HIV treatments. Most studies have been conducted in settings where insurance is required to pay for medical care. Therefore, investigators in British Columbia, Canada, which has provided free anti-HIV drugs to its residents since 1992, analysed HIV-related deaths in the province between 1995 and 2001 and compared the characteristics of patients who died without receiving drugs to those who died after receiving HIV therapy. Investigators also conducted a subanalysis that looked at the amount of HIV therapy that people who received it took before death.
A total of 1094 HIV related deaths were recorded between 1995 and 2001. The investigators selected 1995 for the start of their study, as this was the first year in which a significant fall in HIV-related mortality was recorded.
HIV drugs were used by 833 individuals (67.2%) before death, with the remaining 406 patients (32.8%) dying of an HIV-related cause without ever access antiretroviral therapy.
In multivariate analysis native Americans (adjusted odds ratio [AOR] 0.60, 95% CI: 0.41 – 0.87, p=.008), women (AOR 0.68, 95% CI: 0.47 – 0.99, p=.44), and people on lower than average income (AOR 0.71, 95% CI: 0.54 – 0.92, p=0.11/per $10,000 CD decrease), were found to be more likely to have died without having accessed antiretroviral therapy.
In addition, investigators found that even when anti-HIV therapy was prescribed before death, the majority of patients (454, 54.5%) received antiretroviral drugs less than 75% of the time in the first year of treatment. Receiving treatment less than 75% of the time is an acknowledged risk factor for an increased risk of mortality.
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The investigators comment, “even in a setting where all health care is provided free of charge by the state, high HIV/AIDS death rates persist because of the lack of, or only marginal access to, antiretrovirals.” Native Americans, women and people on low income were at greatest risk of dying without taking anti-HIV drugs. In addition, fewer than half of those who received anti-HIV therapy before death took it consistently, and again social and demographic factors were found to be involved. The investigators conclude “novel health care interventions and the expansion of illicit drug treatment will be required to improve access to antiretrovirals and HIV/AIDS care among populations with poor access.”
Further information on this website
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Wood E et al. Prevalence and correlates of untreated human immunodeficiency virus type 1 infection amongst persons who have died in the era of modern antiretroviral therapy. Journal of Infectious Diseases 188 (online edition), 2003.