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Treatment exhaustion of highly active antiretroviral therapy (HAART) among individuals infected with HIV in the United Kingdom: multicentre cohort study

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38369.669850.8F (Published 24 March 2005) Cite this as: BMJ 2005;330:695

HIV/AIDS Demographics Similar in Dauphin County, Pennsylvania USA

I read with interest the important study of Sabin et al regarding the increasing minority of individuals from six (6) Southeast England HIV treatment centres who may need newer antiretroviral treatment to offset exhaustion of existing treatment options. (1) I appreciate their fine work.

From this side of the Atlantic, I also thought that it might be of interest to compare the demographics of their cohort with a much smaller, but growing population of identified HIV-infected individuals from Dauphin County, Pennsylvania, USA. My information comes from the US Bureau of Census and the HIV/AIDS Surveillance-Bureau of Epidemiology Data Support- Bureau of Health Statistics and Research, Pennsylvania Department of Health.

Briefly, Dauphin County is in Southeast-Central Pennsylvania, an eastern US state adjacent and south of New York and approximately 2 hours by car north-northwest of the Washington, DC metroplex. The county is 525 square miles with an estimated 2003 population of 253,388 persons. The racial breakdown, according to the 2000 census, is 77.1% white/Caucasian, 16.9% black/Afro-American, 4.1% Hispanic and 2% Asian. Approximately 14.1% of the population is over the age of 65. The median yearly household income is approximately $ 41,000. Slightly less than 10% of the population lives below the ‘poverty line.’

From the HIV/AIDS Surveillance Bureau and the Pennsylvania Department of Health, there were 401 living AIDS cases identified in the county in 2003 of which 72% were male. (That number has steadily increased from a figure of 283 cases identified in 1998.) 47% of those cases were white, 41% were Afro-American and 12% were Hispanic. The identified modes of transmission were as follows: 39% were men having sex with men, 27% from IV drug use, 21% from heterosexual sex, 8% from men having sex with men who were also IV drug users and the remaining 4% from a coagulation disorder(1), undetermined/other(2) and pediatric(1). 73% of cases were first diagnosed when the individuals were between 30 and 49 years of age and another 17% in the age range from 20-29.

The Dauphin County, Pennsylvania USA population of persons living with AIDS faces the same problems identified by Sabin et al. Newer drugs with lower toxicity and less cross resistance are likewise needed here.

(1) Sabin, CA, et al. Treatment exhaustion of highly active antiretroviral therapy (HAART) among individuals infected with HIV in the United Kingdom: multicentre cohort study. BMJ 2005; 330:695

Competing interests: None declared

Competing interests: No competing interests

30 March 2005
Stefan P. Kruszewski
Psychiatrist-addictionologist
Harrisburg, Pennsylvania