ABSTRACT
OBJECTIVE: To investigate adherence to antiretroviral therapy and use of alternative therapies among older human immunodeficiency virus (HIV)-infected adults, and to assess relationships between antiretroviral adherence and clinical outcomes. METHODS: One hundred older HIV-infected patients, aged 50 and over, treated at two large HIV clinics in Washington, DC, were enrolled. A cross-sectional methodology used structured interviews to investigate antiretroviral regimens, use of alternative therapies, and demographics. Medical records provided viral load and CD4 count within 3 months of interview. RESULTS: The mean self-reported adherence was 94%, and 55 patients reported 100% adherence to antiretroviral therapy. Correlation analysis showed a significant negative correlation between adherence and viral load (r = -312, p = 0.005). There was no significant difference in adherence based on race, gender, mode of transmission, or education. Twenty-one patients (21%) reported the use of an alternative therapy, with several patients using multiple alternative therapies. There was no significant difference in adherence score (p = 0.514) or viral load (p = 0.860) based upon use of alternative therapies. CONCLUSIONS: Older HIV-infected study patients reported high levels of adherence to antiretroviral regimens, and adherence was highly correlated with HIV viral load. Use of alternative therapies did not significantly impact adherence to antiretroviral agents or viral load. High adherence among this older population may be related to older patients' familiarity with medication usage, their increasing awareness of HIV as a disease that requires optimal adherence, and educational efforts promoted by the two clinics in which they are clients.
Subject(s)
Anti-HIV Agents/therapeutic use , Complementary Therapies/statistics & numerical data , HIV Infections/drug therapy , Patient Compliance , CD4 Lymphocyte Count , Cross-Sectional Studies , District of Columbia , Female , Humans , Male , Middle Aged , Treatment Outcome , Viral LoadABSTRACT
PURPOSE: To evaluate the anesthetic effect of single-point low-volume peribulbar anesthesia supplemented by topical anesthesia. SETTING: Private ambulatory ophthalmic practice. METHODS: Five hundred consecutive patients received 4 cc of lidocaine 2% with 200 units hyaluronidase as 1-point peribulbar anesthesia. This was supplemented by lidocaine 4%, 1 drop every 3 to 5 minutes for 3 instillations. Phacoemulsification and intraocular lens implantation were performed through a scleral tunnel or clear corneal approach. All patients were evaluated for intraoperative akinesia, lid closure, and anesthesia. One hour after surgery, the eye patch was removed and patients were evaluated for pain, discomfort, foreign-body sensation, diplopia, and lid closure. RESULTS: All patients had no pain to mild discomfort during surgery; 34% had total and 58% partial akinesia; 78% had poor orbicularis action (lid closure); 12% had subconjunctival hemorrhage. Postoperatively, 42% of patients had foreign-body sensation caused by conjunctival coaptation by diathermy or corneal edema. Diplopia occurred in 32% of patients but resolved within 1 hour after eye-patch removal, and partial ptosis occurred in 58%, resolving within 2 hours of patch removal. All patients had normal lid closure when the eye patch was removed. CONCLUSIONS: Low-volume 1-point peribulbar anesthesia supplemented by topical anesthesia was safe and effective and provided early visual recovery. Topical therapy can be started 1 hour postoperatively.
Subject(s)
Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Lidocaine/administration & dosage , Orbit/drug effects , Phacoemulsification , Administration, Topical , Adult , Aged , Aged, 80 and over , Eye Movements , Female , Humans , Injections , Male , Middle Aged , Pain Measurement , Pain, Postoperative/physiopathology , Patient SatisfactionABSTRACT
A case of penile agenesis with dysplastic horseshoe kidney, bilateral ureteropelvic junction obstruction, and aganglionic megacolon is presented. Embryologic and practical considerations are discussed. We believe this to be the only known case of this congenital anomaly associated with body segmental renal dysplasia and aganglionic megacolon.
