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- Title
Adherence and health care utilization in HIV/AIDS-rational or rationalizing?
- Authors
Wu, Albert W; Wu, A W
- Abstract
Stock in rationality seems banefully low these days, hovering somewhere around the level of the Euro. Surveys seem to indicate that many Americans have no more regard for rational thinking than they do for feng shui, relegating logic to "one way to think about things" when making decisions. Numerous studies show that people repeatedly violate the basic principles of rationality. Some might find this situation emblematic of the gulf between current therapy for HIV and the behavior of people at risk for and living with HIV. Herculean efforts, including rational drug development, have yielded agents that can arrest viral replication and prolong survival in a disease that was uniformly fatal. However, many patients do not benefit fully from the availability of such therapy. Studies suggest that adherence rates as high as 95% may be necessary to avoid drug resistance. In the real world, less than 40% of patients starting protease inhibitors are able to maintain full viral suppression for a prolonged period. In addition, while the incidence of potentially fatal opportunistic complications of HIV can be lowered dramatically by prophylactic medication such as trimethoprim-sulfamethoxazole, nearly a third of patients with advanced disease do not take this medication, and others with known HIV infection nonetheless first present to medical care in the throes of a potentially preventable infection.
- Subjects
MEDICAL care use; REASONING; AIDS patients; HIV-positive persons; DECISION making; ATTITUDE (Psychology)
- Publication
JGIM: Journal of General Internal Medicine, 2000, Vol 15, Issue 12, p891
- ISSN
0884-8734
- Publication type
editorial
- DOI
10.1046/j.1525-1497.2000.01008.x