Abstract. Park WB, Choe PG, Kim SH, Jo JH, Bang JH, Kim HB, Kim NJ, Oh M, Choe KW (Seoul National University College of Medicine, Seoul, South Korea). One-year adherence to clinic visits after highly active antiretroviral therapy: a predictor of clinical progress in HIV patients. J Intern Med 2007; 261: 268-275.Objective. To determine whether adherence to clinic visits early after initiation of highly active antiretroviral therapy (HAART) is predictive of long-term clinical outcome.Design. Observational cohort study.
Setting. A tertiary referral hospital.Subjects. A total of 387 adult HIV patients who were followed for at least 1 year after initiation of HAART between January 1998 and December 2004.Main outcome measurements. The effect of 1-year adherence to clinic visits on the occurrence of new AIDS-defining illness or death was assessed using Kaplan-Meier survival estimates, and hazard ratios were estimated using Cox proportional hazards regression model.Results. Multivariate analysis revealed that advanced clinical stage, fewer new drugs in HAART, and longer total elapsed time without clinical visits for 1 year after HAART were all significant risk factors for the occurrence of new AIDS-defining illnesses or death. Compared with no missed visits, the hazard ratio adjusted by clinical stage and number of new drugs in HAART was 2.87 (95% confidence interval [CI], 1.34-6.16, P ¼ 0.007) for one missed appointment, 4.37 (95% CI: 1.74-10.98, P ¼ 0.002) for two, and 8.19 (95% CI: 2.95-22.78, P < 0.001) for three or more.Conclusion. Adherence to clinic visits early after initiation of HAART is an independent predictor for longterm clinical progression in HIV patients.
Work engagement and organizational commitment are among the most studied topics in a range of fields, including human resource development (HRD) and organization development (OD). The value of such work is evident in the direct influence of work engagement and organizational commitment on employee well-being and organizational performance. However, scholars have divergent perspectives on the relationship between these two concepts. While some studies have examined work engagement as a precursor to organizational commitment, others have investigated work engagement as an outcome of organizational commitment. Despite the contrasting perspectives, little research effort has been made to reconcile these differing views through the synthesis and analysis of the extant literature. Therefore, this study aims to examine the current state of engagement-commitment research and then to suggest HRD implications for research and practice based on a review of selected literature.
Although the importance of the initial regimen in highly active antiretroviral therapy (HAART) has been emphasized, the effect on clinical outcome of early modification of the initial HAART regimen has not been well-defined. The analysis included antiretroviral-naive HIV patients who started HAART between 1999 and 2005 at a university hospital. Early modification was defined as any drug change within 2 months of starting HAART. The effect of early regimen modification on the occurrence of new AIDS-defining illness or death was assessed using Kaplan-Meier survival estimates, and hazard ratios were estimated using Cox's proportional hazards regression model. Of 398 patients beginning HAART, 21% experienced early modification of their regimen, the most common reason being gastrointestinal toxicity (49%). After adjusting for risk factors for occurrence of a new AIDS event or death, identified by univariate analysis, the hazards ratio contrasting early modification with maintenance of initial HAART regimen was 3.06 (95% confidence interval, 1.36-6.90; p = 0.007). There were significant differences between the AIDS event-free survival curves of patients in clinical categories B or C with or without early modification of initial HAART regimen (p = 0.0002), but no significant difference in patients in clinical category A (p = 0.706). A considerable proportion of patients who started HAART changed treatment regimen mainly due to intolerance early after start of HAART. Early modification of an initial HAART regimen was associated with poor clinical outcome in HIV patients in the advanced clinical categories.
Little is known about the effect of immune reconstitution inflammatory syndrome (IRIS) on the long-term clinical outcome. Of 52 opportunistic infections (OI) occurring within one year after the start of HAART in 387 HIV patients, 33 (63%) were classified as having IRIS. The patients with IRIS showed no significant difference in the AIDS event-free survival curve compared with the matched control group without OI and in contrast to non-IRIS OI.
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