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Mitchell H. Katz, MD; Andrew B. Bindman, MD; Dennis Keane, MPH; Allen K. Chan

Arch Intern Med. 1992;152(7):1501-1504.

Abstract
Background.—
As many as half of patients infected with the human immunodeficiency virus who are medically eligible for Pneumocystis prophylaxis and zidovudine treatment have not received these treatments. We used the CD4 lymphocyte count as an indicator of delay in seeking treatment among patients infected with human immunodeficiency virus and assessed whether insurance status was associated with the stage of illness when care is initiated.

Methods.—
Data from 96 patients who initiated medical care at a university acquired immunodeficiency syndrome clinic from August 1989 to January 1991 were retrospectively reviewed.

Results.—
Patients initiated care at a relatively late stage of illness (mean CD4 lymphocyte count, 0.37 x 109/L [36⁹/ mm³]), and 29% were below the threshold for Pneumocystis prophylaxis. Patients with private insurance had significantly lower CD4 counts (mean, 0.27x10⁹/L) than did individuals with public insurance (mean, 0.46 x 10⁹/L). CD4 counts did not increase during the 18-month study period.

Conclusions.—
The majority of patients infected with human immunodeficiency virus are eligible for medical therapy and could benefit by initiating care sooner. Private insurance was not associated with initiating early care, supporting anecdotal reports that some privately insured individuals may be reluctant to seek care for a human immunodeficiency virus—related condition.

(Arch Intern Med. 1992;152:1501-1504)

Author Affiliations
From the Department of Public Health, San Francisco, Calif (Dr Katz); and Divisions of General Internal Medicine, University of California, San Francisco (Dr Katz and Mr Chan) and San Francisco General Hospital (Dr Bindman and Mr Keane).

Footnotes
Accepted for publication January 17, 1992.

Presented at the VII International Conference on AIDS, Florence, Italy, June 17, 1991.

Reprint requests to Research Branch, AIDS Office, 25 Van Ness Ave, Suite 500, San Francisco, CA 94102-6033 (Dr Katz).

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