Does Use of Potent Antiretroviral Therapy Differ by Health Care Setting?

To the Editor: Dr Detels and colleagues¹ reported that 141 (49%) of 288 patients followed up in a variety of health care settings between July 1995 and July 1997 were receiving potent antiretroviral therapy (PART). We have been asked repeatedly whether financial considerations impede prescribing PART in a managed-care setting. To investigate this question, we reviewed the computerized and hard copy medical records of the 1839 patients who tested positive for the human immunodeficiency virus (HIV) who attend either the San Francisco or Hayward facilities of Kaiser Permanente Medical Care Program, a not-for-profit health plan. We determined whether those patients having CD4⁺ lymphocyte counts less than 500/mm³ (0.50 × 10⁹/L) or HIV RNA levels of 10,000 copies/mL or greater had received a supply of 3 or more antiretroviral medications for 2 or more consecutive months between January 1, 1996, and June 30, 1998.