Adherence to antiretroviral therapy (ART) represents one of the strongest predictors of progression to AIDS, yet it is difficult for most patients to sustain high levels of adherence. This study compares the efficacy of a personalized cell phone reminder system (ARemind) in enhancing adherence to ART versus a beeper. Twentythree HIV-infected subjects on ART with self-reported adherence less than 85% were randomized to a cellular phone (CP) or beeper (BP). CP subjects received personalized text messages daily; in contrast, BP subjects received a reminder beep at the time of dosing. Interviews were scheduled at weeks 3 and 6. Adherence to ART was measured by self-report (SR, 7-day recall), pill count (PC, past 30 days at baseline, then past 3 weeks), Medication Event Monitoring System (MEMS; cumulatively at 3 and 6 weeks), and via a composite adherence score constructed by combining MEMS, pill count, and self report. A mixed effects model adjusting for baseline adherence was used to compare adherence rates between the intervention groups at 3 and 6 weeks. Nineteen subjects completed all visits, 10 men and 9 females. The mean age was 42.7 AE 6.5 years, 37% of subjects were Caucasian and 89% acquired HIV heterosexually. The average adherence to ART was 79% by SR and 65% by PC at baseline in both arms; over 6 weeks adherence increased and remained significantly higher in the ARemind group using multiple measures of adherence. A larger and longer prospective study is needed to confirm these findings and to better understand optimal reminder messages and user fatigue.

Sofosbuvir-based direct-acting antiviral therapy is safe and effective in a cohort of patients with CKD infected with hepatitis C.

Background The frequency of hypothalamic-pituitary-adrenal (HPA) axis dysfunction among HIV-infected patients receiving steroid injections has not been reported, and risk factors for this adverse event are poorly characterized. Methods We conducted a retrospective analysis of data from HIV-infected patients in the Partners HealthCare system (Boston, MA) who received corticosteroid injection(s) between 2002 and 2011. Chart review focused on HIV status, antiretroviral therapy (e.g., protease inhibitors (PI)), steroid injection(s), and adrenal axis dysfunction (e.g., adrenal insufficiency (AI) and/or Cushing's syndrome). Because all cases occurred among patients on PIs, we performed additional detailed data extraction and conducted univariate and multivariate analyses to identify risk factors in this group. Results 171 HIV-infected patients received ≥1 corticosteroid injection(s) in the study period. Nine cases (event frequency, 5.3%; 95% CI, 2.4%-9.8%) of secondary AI were diagnosed; five (55%) of these nine patients also had clinical evidence of Cushing's syndrome. All cases occurred among the 81 patients on PIs (event frequency among those on PIs, 11.1%; 95% CI, 5.2%-20.0%). Among patients on PIs, the major risk factor for HPA-axis dysfunction was having ≥2 injections within 6 months. Conclusions In this retrospective cohort study, 11% of HIV-infected patients on PIs at the time of steroid injection were later diagnosed with HPA axis dysfunction. Corticosteroid injections in HIV-infected patients on PIs should only be used with great caution and close monitoring.