Use of Antiretroviral Therapy by Intravenous Drug Users With HIV

To the Editor: Our experience in Harlem with the antiretroviral treatment of HIV-infected IDUs is quite different from that reported by Dr Celentano et al¹ and by Dr Strathdee et al.² These authors report ART use among 51% and 40%, respectively, of HIV-infected IDUs surveyed. In contrast, 78% (58/74) of HIV-infected IDUs under our care were found to be receiving ART in a cross-sectional survey conducted in January 1998.³ Our patients participate in a unique program that we developed for providing on-site HIV care at hospital-affiliated methadone maintenance treatment centers. This program provides HIV primary care administered by physicians trained in infectious disease with extensive experience treating persons with HIV. Patients in this program reflect the Harlem community, with 66% blacks, 31% Latinos, and 38% women. A significant proportion of those receiving ART (64% [37/58]) were receiving protease-containing regimens. Forty-one percent (23/56) of patients receiving ART had undetectable HIV RNA levels (<400 copies/mL). While no association was found between ART use and age, sex, or race, there was a trend toward the persons receiving ART having lower CD4-lymphocyte counts (P = .07).