Background: Planning the home care of growing numbers of old, dependent people must include the caregivers' burden. Methods: A convenience sample of 129 caregivers of elderly patients with multiple diagnoses was interviewed about the caregiving context, burden, caregivers' tolerance of patients' troublesome behaviours and physical symptoms, mutuality and feelings of closeness between caregiver and patient. Continued maintenance of home care was assessed by a follow-up telephone call. Results: Caregivers were mainly spouses (67%) and female (73%), and the mean duration of care was 5.5 years. In five activities of daily living (ADL) 50-69% of the patients needed full help. Caregivers reported predominantly negative effects of caregiving on their physical and mental health, rest and sleep, leisure time and social life, problems with patients' symptoms and behaviours and little or no conversing (51%) or exchanging feelings with patients (71%). Predictive models: Contributors to variance were for burden (35%), impact of care on caregivers' mental health, social relations and leisure time, patients' gender, accumulation of patients' symptoms and behaviours; for caregivers' tolerance toward patients' symptoms and behaviours (17%) caregivers' physical health, patients' level of confusion, feelings of mutuality; for mutuality (22%) and for closeness (19%) caregivers' mental health, patients' accumulation of symptoms and behaviours. Within 23 months 19% of the patients had been institutionalized. Factors giving a higher likelihood of instrtutionalization were: being male, caregiver was not a partner, and less closeness between caregiver and patient. Conclusion: Caregiving of older persons has bio-psychosocial ramifications for caregivers. Closeness between caregiver and patient seems to be a key factor in determination of the long-term outcome.

ObjectivesTo compare the response to ritonavir (RTV) plus saquinavir (SQV) with single protease inhibitor (PI) therapies among PI-naive HIV-1 infected individuals. MethodsResponse to treatment was analysed according to the intent-to-treat principle in a prospective observational cohort study of 177 patients who between May 1995 and March 2000 started a double PI therapy with RTV and SQV (nonboosting dosages) plus at least one nucleoside reverse transcriptase inhibitor (NRTI) and 2214 patients with a single PI therapy plus two NRTIs. We used survival analysis and Cox's proportional hazard regression methods. The primary endpoint was the time to a plasma viral load of <400 copies/mL. Secondary endpoints were taken as a gain in the CD4 count of >100 cells/mL, and change of initial PI for any reason. ResultsBaseline characteristics in both treatment groups were balanced. Median follow-up in both groups was 10.4 months. Time to an HIV-1 viral load of <400 copies/mL and an increase in the CD4 count of >100 Â 10 6 cells/L was shorter for RTV plus SQV compared with single PI regimens (log rank test for each endpoint P <0.05). The adjusted hazard ratios of RTV plus SQV compared with single PI regimens were 1.21 (95% con®dence interval 0.99±1.47) for achieving an HIV-1 viral load of <400 copies/mL, 1.12 (0.88±1.42) for an increase in the CD4 count of >100 cells/mL, and 0.90 (0.73±1.11) for change of ®rst PI regimen. ConclusionsTreatment with RTV plus SQV compared with single PI regimens appeared to give similar results for virological or immunological response.Keywords: antiretroviral therapy, HIV infections, prospective cohort study, protease inhibitors IntroductionThe introduction of potent antiretroviral therapy has lead to a dramatic reduction in HIV-related morbidity and mortality [1±3]. Generally, a potent antiretroviral therapy consists of one protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitors (NNRTI) combined with at least two nucleoside reverse transcriptase inhibitors (NRTI). Pharmacokinetic studies have shown that ritonavir (RTV) may boost serum levels of other PIs such as saquinavir (SQV) and indinavir (IDV), and has lead to the introduction of dual PI therapies. ORIGINAL RESEARCHSeveral studies have demonstrated that the combination of RTV plus SQV reduces plasma HIV-1 viral load to a similar extent to that of a single PI-based regimen [4±9]. These studies, however, either did not use control groups, reported only 24 weeks follow-up data, or compared different dosing or intensi®cation regimens of RTV plus SQV. There is very little evidence from controlled trials in PI-naive patients comparing the dual PI therapy of RTV plus SQV with single PI regimens. In one randomized controlled trial, the dual combination of RTV plus SQV showed superior short-term antiretroviral activity when compared with single protease regimen with either IDV or RTV [10]. However, the limited number of included patients and the short follow-up period limit the generalizability of these study ®ndings.The goal of ...

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