Prescribing Protease Inhibitors for the Homeless

To the Editor.  —It was gratifying to read the balanced discussion on the use of protease inhibitor therapy in the homeless population.¹ Some bioethicists and clinicians have been quoted in the popular press as regarding as unethical the withholding of such therapy. However, blanket pronouncements do not take into account the dismal state of the art of treatment for mentally ill, chemically dependent patients.As a primary care physician in a walk-in center for homeless persons with serious and persistent mental illness, I am pessimistic as to the success of combination chemotherapy in a substantial proportion of such patients. It is hard to imagine many of these patients literally sitting still long enough for me to pronounce the names of the new antiviral drugs, much less to discuss the indications, potential adverse effects, dosage regimens, drug and food interactions, and monitoring requirements.In the past 6 years, I have