Calcium and Vitamin D Use among Older Adults in U.S.: Results from National Survey.

OBJECTIVE: This study was conducted to describe a 10-year trend of the supplement from 2000 to 2009 and to evaluate age, gender and racial disparities using a national level health data. DESIGN: Cross-sectional observational study. SETTING AND PARTICIPANTS: Data collected from patient visit records to stand-alone US ambulatory care clinics. Visits made by men and women who were 40 years of age and older were included (n=175,830). MEASUREMENTS: Overall prevalence of recorded calcium and vitamin D use for osteoporosis prevention and treatment, and annual visit rates were estimated by age, gender, race, insurance types, physician specialties, geographical regions, and metropolitan status using chi square test. Multivariate logistic regression was conducted to determine potential predictive factors for calcium and vitamin D supplements. RESULTS: An increase in yearly trend of calcium and vitamin D supplements was observed. The increase was proportional to patients' age (p<0.05) and female gender was a strong predictor of calcium and vitamin D supplement (p<0.0001).Visits made by blacks were significantly less likely to be associated with the supplement (<0.05). Visits associated with self-pay and Medicaid was less likely to be recorded with vitamin D (p<0.05) but not calcium supplements. Osteoporosis diagnosis was an independent predictor of calcium and vitamin D records (p<0.0001). CONCLUSIONS: In spite of the observed increases in the trend of visits associated with calcium and vitamin D supplements, variability in the access to the medications was observed. More focused strategies targeting elderly, men, or black population are needed to maintain and improve adequate calcium and vitamin D supplements.

Health-Related Quality of Life and CD4 Cells Status of Patients Receiving Antiretroviral Therapy in Nigeria

Background: The goals of antiretroviral therapy (ART) are to improve patient's health-related quality of life (HRQOL) and restore immunologic function among others. Objectives: The study evaluated HRQOL and CD4-cells response of HIV-infected patients at months 0 and 6 of receiving ART in Maitama District Hospital Abuja, Nigeria. Methods: HRQOL of a cohort of 150 HIV-infected patients was evaluated at months 0 and 6 of receiving ART using Medical Outcomes Study Short Form-36 (MOS SF-36) which has 8 domains. These include physical functioning, physically and emotionally related role limitations, social functioning, pain, energy/fatigue, emotional well-being and general health. A paired samples t-test was used to compare the HRQOL scores and CD4 cells count of participants at months 0 and 6. Wilcoxon's signed-ranks test was used to compare HRQOL of male and female participants. At two-tailed test, p value of <0.05 was considered significant. Results: The mean age (±SD) of the 150 participants at ART initiation was 34.3 ± 8.4 years; 59.3% were females. The mean (±SD) HRQOL of participants increased significantly from 71.9% ± 20.9 at ART initiation to 89.7% ± 10.6 after 6 months of ART (p<0.05). The change in all SF-36 domains was statistically significant (p<0.05) except for the domains of role limitation due to emotional problems, social functioning and pain. The improvement in the mental component score (MCS) was significant (p<0.05) unlike that of the physical component (PCS). The difference in the HRQOL of male and female participants at months 0 and 6 was not significant. The mean CD4 cell count (±SD) increased from 185.7 ±91.0 cells/mm3 at month 0 to 199.0 ±104.7 cells/mm3 after 6months of ART; though this increase was not statistically significant. Conclusion: There was significant improvement in the mean HRQOL scores of participants which was not associated with significant improvement in the CD4 cells status after six months of ART. The evaluation of HRQOL alongside the clinical and immunological parameters when monitoring treatment outcomes is recommended

Antiretroviral adherence and use of alternative therapies among older HIV-infected adults.

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.

Survival differences associated with treatment of cytomegalovirus retinitis in Maryland patients with AIDS, 1987-1994.

Differences in survival related to treatment of cytomegalovirus (CMV) retinitis in AIDS patients were studied. The medical records of adult AIDS patients who had been diagnosed with CMV retinitis in a Maryland inpatient facility between September 1987 and September 1994 were reviewed to assess determinants of survival, including treatment with ganciclovir and foscarnet, use of zidovudine, and demographic characteristics. The review was based on inpatient and outpatient medical records and computerized data from the Maryland HIV Information System. Of 212 AIDS patients with CMV retinitis, 123 (58.0%) were treated exclusively with ganciclovir, 55 (25.9%) received foscarnet only, and the remaining 34 (16.1%) received both ganciclovir and foscarnet at some point after their diagnosis for CMV retinitis. Patients who received both drugs survived significantly longer after the diagnosis than patients who received either drug by itself. The median time from diagnosis of CMV retinitis to death was 464 days for patients receiving both drugs, 225 days for ganciclovir recipients, and 202 days for foscarnet recipients. Other positive predictors of survival were male sex and use of zidovudine. Among Maryland adults with AIDS who were treated for CMV retinitis between September 1987 and September 1994, the most common treatment for the eye infection was ganciclovir. Patients receiving both ganciclovir and foscarnet survived longer than those treated with either drug alone.

A characterization of older AIDS patients in Maryland.

This retrospective study evaluated Maryland acquired immunodeficiency syndrome (AIDS) patients who were > or = 50 years at the time of AIDS diagnosis. All patients diagnosed between January 1987 and June 1996 who were > 50 years were included in the cohort. A total of 610 male (82.7%) and 128 female (17.3%) AIDS patients aged > or = 50 were identified. The most common mode of human immunodeficiency syndrome (HIV) transmission was male-to-male sexual contact (34.7%). Additionally, 146 (19.8%) patients contracted HIV through blood transfusions, 93 (12.1%) were infected through heterosexual contact, 134 (18.6) were infected through i.v. drug abuse, and the remaining 109 (14.8%) had unknown risk factors. Data from this preliminary study demonstrate that an alarming percentage of AIDS patients (approximately 10%) in Maryland are aged > or = 50. Sexual contact, either male-to-male or heterosexual transmission, was the route of transmission for nearly 47% of this patient population. However, few research projects, educational programs, or public health initiatives are specifically targeted to this patient population. The increasing life expectancy of AIDS patients as well as the advent of new drug treatments highlights the need for further research to investigate the diagnosis and treatment of AIDS and HIV infection among older patients.

Race and the treatment of cytomegalovirus retinitis in a cohort of patients with acquired immunodeficiency syndrome.

This historical cohort study assessed the impact of race on critical factors in the diagnosis and drug treatment of cytomegalovirus (CMV) retinitis in acquired immunodeficiency syndrome (AIDS) patients over a 7-year period. The study subjects included 194 adult patients with a history of AIDS who were treated for CMV retinitis between September 1987 and September 1994. Abstracted inpatient hospital medical records and a statewide automated AIDS database were the primary sources of data. Patients were assessed for severity of CMV retinitis at diagnosis, time from initial CMV retinitis diagnosis to first treatment, survival from diagnosis of AIDS, and initiation of drug treatment for CMV retinitis. Results indicated a significant difference in the severity of CMV retinitis at diagnosis by race. Patients diagnosed with early disease were more likely to be white, whereas patients diagnosed with severe disease were more likely to be black. There was no difference in the type of CMV retinitis treatment or patient survival time after diagnosis, nor time to treatment once diagnosed by race. These results suggest that differences in survival may not be the result of discrimination against black patients and may be due more likely to practices associated with accessing medical treatment.