Inner city HIV patients frequently do not receive specialized care or follow recommended treatment

Chicago -- Significant advances in antiretroviral therapy are helping thousands of HIV patients keep the virus at bay, allowing them to live nearly normal lives and avoid progressing to full-blown AIDS. In the inner city, however, only a small percentage of individuals diagnosed with HIV take advantage of available treatments, with the result that less than 1 in 10 has a successful treatment outcome, according to recent research at Emory University School of Medicine and Atlanta�s Grady Health System. Carlos del Rio, M.D., associate professor of medicine at Emory University School of Medicine, will address the difficulties of treating inner-city HIV patients in an invited lecture at the 8th Conference on Retroviruses and Opportunistic Infections in Chicago on February 7. Dr. del Rio treats HIV inpatients at Atlanta�s inner-city Grady Memorial Hospital and outpatients at the Emory/Grady outpatient infectious disease clinic at the Ponce de Leon Center.

"In light of the recent advances in antiretroviral therapy, we have placed increasing emphasis on early HIV diagnosis and initiation of treatment," says Dr. del Rio. "The Public Health Service�s recent CDC Prevention Strategy includes as two goals increasing the number of patients who are aware of their HIV diagnosis and increasing the number who enter care within three months of diagnosis. But without patient follow through, neither of these goals correlates with successful antiretroviral therapy." To determine the proportion of newly diagnosed patients who entered into care within three months, and who had significant declines in the level of virus, Dr. del Rio and his colleagues studied a group of adult patients at Grady Memorial Hospital in 1999. All the patients were offered social work assistance, and those with an AIDS-defining condition were referred to the outpatient clinic. Of the 135 patients newly diagnosed with HIV, 24 (18%) died within one year of diagnosis. Of the remaining patients, 103 were eligible for follow-up at the outpatient clinic, but most patients dropped out of care within a few months of diagnosis. Only 55 (53%) actually went to the clinic, and 22 of those (40%) dropped out of care within one year. Antiretroviral therapy was prescribed during the year following diagnosis to 30 of the 55 patients, and at some point 20 achieved an undetectable level of virus. One year after diagnosis, 23 patients remained on therapy and 12 still had undetectable virus. Thus, only 12% of the original group of patients eligible for care had undetectable virus levels at one year after diagnosis.

"Our results show that there is a vast difference between being able to detect HIV and gaining treatment compliance, " says Dr. del Rio. Unfortunately, the road between diagnosis and therapeutic success in this inner-city setting is truly a road less traveled.

Because the HIV epidemic is increasingly affecting minorities and disadvantaged populations, there is a need to design better interventions to address this important issue.

Dr. del Rio recently launched the Atlanta arm of a new study, funded by the Centers for Disease Control and Prevention (CDC), called the Antiretroviral Treatment and Access Study (ARTAS). The four-year study also has sites in Baltimore, Los Angeles and Miami and will try to determine whether case-management intervention will improve attendance and use of health care services by "disadvantaged" persons newly diagnosed with HIV. In Atlanta, the study will be conducted at Grady Memorial Hospital and other Atlanta-area health care providers and testing centers. It will try to "bridge the gap" between HIV diagnosis and entry into care.