Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens.

BACKGROUND: Adherence to prescribed medications is a central feature of good clinical HIV care, but little is known about the factors associated with multidrug antiretroviral adherence, or about how such adherence is related to plasma HIV suppression. METHODS: We collected data from 133 HIV-infected adults receiving antiretroviral therapy. Study subjects completed customized adherence self-report instruments and provided blood samples to measure plasma HIV-1 RNA concentrations and CD4+ lymphocyte counts. Regression models were used to determine the independent predictors of antiretroviral adherence and plasma HIV concentration, and the relationships between the two. RESULTS: Adherence was poor (average, <80% antiretrovirals/day) in 28% (95% confidence interval [CI], 20%-36%), fair (80%-99% per day) in 23% (95% CI, 15%-30%), and excellent (100% per day) in 50% (95% CI, 41%-58%) of study subjects. Mean decreases in HIV-1 concentration from highest-ever levels were 1.3, 1.6, and 2.0 log10 copies/ml in these three groups, respectively (chi2; p < .02). Two-stage least squares regression demonstrated a -1.3 log difference in viral load associated with each category improvement in adherence. In multivariate models, confidence in medication-taking ability, or perceived self-efficacy, and convenience of the medication regimen, or "fit" with routine and daily activities, were also associated with greater medication adherence (odds ratios [OR] 5.3; 95% CI, 2.4-11.8, and 9.0; 95% CI, 1.8-45.3, respectively). The latter was also independently associated with a lower plasma HIV concentration (p < .02). CONCLUSIONS: Nonadherence to combination antiretroviral medications is common and is associated with increased levels of plasma HIV. Programs and clinical efforts to improve medication taking should strive to integrate medications better into patients' daily routines and to improve patients' confidence in their ability to take medications correctly.

Developing coxal joint of the dog: gross morphometric and pathologic observations.

The growth and development of the proximal parts of femurs and the acetabula were studied in 32 English Pointers. The dogs were allotted to 8 age groups, birth through 9 months of age. Dogs were euthanatized, and at necropsy, 6 linear measurements were made on the proximal part of each femur: the cranial-caudal and the dorsal-ventral diameters of the femoral head, and the widths of the articular surface of the head from the center of the fovea to the cranial, caudal, dorsal, and ventral articular margins. Also 7 linear measurements were made on each acetabulum, including the cranial-caudal and the dorsal-ventral diameters, the length and width of the acetabular fossa, and the width of the lunate surface from the acetabular lip to the acetabular fossa in 3 places. All of the linear values increased rapidly during the first 4 weeks of life and slowly thereafter, and most of them increased simultaneously and proportionately. By 9 months of age, average body weight had increased by a factor of 52 (from initial 0.4 kg to 20.9 kg) and the diameter of the femoral heads and acetabula had increased by a factor of 4.5. Other coxal joint features were also evaluated, including the relative thickness of the joint capsule, the presence of fraying or disruption of the ligament of the femoral head, and the smoothness and regularity of the articular surfaces. Coxal joints in the younger dogs were free of grossly detectable pathologic changes. However, abnormalities of various joint components were present in 1 of the 6 dogs in the 5-month age group, in 2 of the 6 dogs in the 7-month age group, and in 4 of the 6 dogs in the 9-month age group.

The systemic arterial pattern of the guinea pig: the pelvis and pelvic limb.

The systemic arterial pattern of 59 guinea pigs was examined by dissection, angiography, or corrosion casting. The blood supply to the pelvis and the pelvic limbs arises as two terminal branches of the aorta, the right and left common iliac arteries, and each of these divides into external and internal iliac arteries. Their pattern of distribution resembles a typical mammalian pattern. The external iliac artery passes throught the body wall to supply the pelvic limb and the internal iliac artery is distributed primarily to the pelvic region and its viscera.

The systemic arterial pattern of the guinea pig: the abdomen.

The systemic arterial pattern of the guinea pig was studied to determine the arrangement of the major arterial trunks and their branches. Fiftynine specimens were examined by dissection, angiography or corrosion casting. The arterial arrangement was found to resemble a typical mammalian pattern, although some exceptions were noted. For example, the guinea pig usually has a single vessel, the celiacomesenteric trunk, instead of separate celiac and cranial mesenteric arteries. The celiac components of this vascular axis were found to originate in four different patterns. Also, the renal arteries were found to be single or double on either side with double origins more frequent.