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Judith A. Cook, PhD, Mardge H. Cohen, MD, Dennis Grey, BA, Lynn Kirstein, MS, Jane Burke, MS, Kathryn Anastos, MD, Herminia Palacio, MD, Jean Richardson, DrPH, Tracey E. Wilson, PhD and Mary Young, MD

Judith A. Cook, Dennis Grey, and Jane Burke are with the Department of Psychiatry, University of Illinois at Chicago. Mardge H. Cohen is with the Core Center, Cook County Hospital, Chicago. Lynn Kirstein is with the Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Md. Kathryn Anastos is with the Department of Medicine, Montefiore Medical Center, Bronx, NY. Herminia Palacio is with the Division of Population Health and Prevention, San Francisco Department of Public Health, San Francisco, Calif. Jean Richardson is with the Department of Preventive Medicine, University of Southern California, Los Angeles. Tracey E. Wilson is with the Department of Preventive Medicine and Community Health, State University of New York Health Science Center at Brooklyn. Mary Young is with the Department of Medicine, Georgetown University Medical Center, Washington, DC.

Correspondence: Requests for reprints should be sent to Judith A. Cook, PhD, Mental Health Services Research Program, Department of Psychiatry, University of Illinois at Chicago, 104 S Michigan Ave, Suite 900, Chicago, IL 60603 (e-mail: cook{at}ripco.com).

Objectives. This study examined longitudinal trends in use of highly active antiretroviral therapy (HAART) among a cohort of HIV-positive participants in the Women's Interagency HIV Study.

Methods. Beginning in 1994, 1690 HIV-positive women reported detailed information about their use of antiretroviral therapy at 6-month study visits. Multivariate logistic and Cox regression analyses were used to estimate the likelihood of antiretroviral therapy and HAART use among women with study visits preceding and following HAART availability.

Results. Before the availability of HAART, the cohort's likelihood of any antiretroviral therapy use was associated with clinical indicators (CD4 count, viral load, symptom presence) as well as behavioral factors (abstaining from drug and alcohol use, participating in clinical trials). After HAART became commercially available, newly emerging predictors included college education, private insurance, absence of injection drug use history, and not being African American.

Conclusions. After the penetration of HAART into this cohort, additional differences emerged between HAART users and nonusers. These findings can inform public health efforts to enhance women's access to the most effective types of therapy.

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