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Potential Impact on Publicly Funded Health Care Resources

Catherine M. Hutchinson, BM,BS; Cara Wilson, MD; Cindy A. Reichart, MT(ASCP); Vincent C. Marsiglia, MT(ASCP), MHA; Jonathan M. Zenilman, MD; Edward W. Hook III, MD

JAMA. 1991;266(2):253-256.

Abstract
Since January 1990, human immunodeficiency virus (HIV)-infected patients attending two sexually transmitted disease clinics in Baltimore, Md, have been offered T-lymphocyte subset evaluations. From January through September, CD4⁺ lymphocyte concentrations were measured in 223 newly diagnosed HIV-infected patients; 50% had fewer than 500 CD4⁺ T cells and 12% had fewer than 200 CD4⁺ T cells per cubic millimeter. Most patients were asymptomatic, and, even among patients with fewer than 200 CD4⁺ T cells, 54% had no symptoms or signs suggestive of advanced HIV infection. Homosexually active men had significantly lower mean CD4⁺ lymphocyte concentrations than intravenous drug users. Given the substantial numbers of patients with CD4⁺ concentrations that qualified them for zidovudine therapy, we also assessed their mechanisms of paying for health care. Only 24% of HIV-infected patients had private insurance. Seventy-two percent of patients with fewer than 200 CD4⁺ T cells either had no insurance or relied on public assistance for health care. Thus, although 50% of asymptomatic individuals identified by routine voluntary HIV screening in an inner-city sexually transmitted disease clinic may benefit from therapy for their disease, 75% of those qualifying for presently recommended therapy either depend on publicly funded health care or have no means of payment for care.

(JAMA. 1991;266:253-256)

Author Affiliations
From The Johns Hopkins University School of Medicine (Drs Hutchinson, Zenilman, and Hook and Ms Reichart), The Johns Hopkins Hospital Department of Medicine (Dr Wilson), Baltimore, Md, and Preventative Medicine and Epidemiology, Baltimore (Md) City Health Department (Mr Marsiglia and Drs Zenilman and Hook).

Footnotes
Reprint requests to The Johns Hopkins Hospital, Infectious Diseases—Blalock 1111, 600 N Wolfe St, Baltimore, MD 21205 (Dr Hook).

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