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Highly Active Antiretroviral Therapy in a Large Urban Clinic: Risk Factors for Virologic Failure and Adverse Drug Reactions

Gregory M. Lucas, MD; Richard E. Chaisson, MD; and Richard D. Moore, MD, MHSc
[+] Article, Author, and Disclosure Information

From Johns Hopkins University School of Medicine, Baltimore, Maryland.

Grant Support: By the Agency for Health Care Policy and Research (R01-H507809) and the National Institute on Drug Abuse (R01-DA11602).

Requests for Reprints: Richard D. Moore, MD, MHSc, 1830 East Monument Street, Room 8059, Baltimore, MD 21205.

Current Author Addresses: Drs. Lucas, Chaisson, and Moore: 1830 East Monument Street, Room 455, Baltimore, MD 21205.

Ann Intern Med. 1999;131(2):81-87. doi:10.7326/0003-4819-131-2-199907200-00002
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Highly active antiretroviral therapy (HAART) has produced dramatic reductions in morbidity and mortality rates associated with HIV-1 infection in the United States (12). In clinical trials, combinations of protease inhibitors, nucleoside analogues, and non-nucleoside reverse transcriptase inhibitors have reduced plasma HIV-1 RNA levels to less than 500 copies/mL in 60% to 90% of patients (37). However, such therapy involves complicated dosing schedules, side effects in a substantial number of patients, and a high degree of adherence to maintain viral suppression (34, 8). Given these difficulties, it has become evident that HAART may be considerably less successful outside of the clinical trial setting (9). Before HAART, reports showed lower survival rates among ethnic minority groups, women, injection drug users, and persons in lower socioeconomic groups with HIV infection (1012). The effect of demographic differences on the success of HAART is unclear.

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