Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study.

BACKGROUND: Adherence to highly active antiretroviral therapy (HAART) for human immunodeficiency syndrome type 1 (HIV-1) infection is essential to sustain viral suppression and prevent drug resistance. We investigated adherence to HAART among patients in a clinical cohort study. METHODS: Patients receiving HAART had their plasma concentrations of protease inhibitors or nevirapine measured and completed a questionnaire on adherence. We determined the percentage of patients who reported taking all antiretroviral medication on time and according to dietary instructions in the past week. Drug exposure was compared between patients reporting deviation from their regimen and fully adherent patients. Among patients who received HAART for at least 24 weeks, we assessed the association between adherence and virologic outcome. RESULTS: A total of 224 of 261 eligible patients completed a questionnaire. Forty-seven percent reported taking all antiretroviral medication on time and according to dietary instructions. Patients who reported deviation from their regimen showed lower drug exposure compared with fully adherent patients (median concentration ratio, 0.81 vs 1.07; P =.001). Among those receiving HAART for at least 24 weeks, patients reporting deviation from their regimen were less likely to have plasma HIV-1 RNA levels below 500 copies/mL (adjusted odds ratio, 4.0; 95% confidence interval, 1.4-11.6) compared with fully adherent patients. CONCLUSIONS: Only half of the patients took all antiretroviral medication in accordance with time and dietary instructions in the preceding week. Deviation from the antiretroviral regimen was associated with decreased drug exposure and a decreased likelihood of having suppressed plasma HIV-1 RNA loads. Patient adherence should remain a prime concern in the management of HIV-1 infection.

Comparison of office and serial automatic blood pressure readings in renovascular and essential hypertension.

Office blood pressures were compared with those obtained using a thirty minute recording with an automatic device (Dinamap) in thirty patients with essential hypertension and nineteen subjects with hypertension and renal artery stenosis. When matched for age and sex, no differences were found between both groups of patients with respect to their office or automatically recorded blood pressures. The difference between office and automatically assessed systolic blood pressures was similar in both groups. The difference in diastolic pressures was slightly larger in the group with renal artery stenosis. The number of patients showing a pressure drop greater than 10 mm Hg was comparable in the two groups. We conclude that blood pressure levels obtained in the office overestimate 'true' blood pressure not only in essential but also in renovascular hypertension.

Clubbing in human immunodeficiency virus infection.

We describe two patients who developed clubbing shortly after HIV seroconversion. None of them had the full syndrome of hypertropic osteoarthropathy. Other causes of clubbing are unlikely. We suggest that clubbing may belong to the spectrum of arthropathies associated with HIV infection.