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Medication adherence among HIV+ adults: effects of cognitive dysfunction and regimen complexity
C H Hinkin1, S A Castellon, R S Durvasula
1Department of Psychiatry & Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA 90024, USA. chinkin@ucla.edu
Neurology
|December 25, 2002
Summary
HIV patients with cognitive impairment and complex medication schedules struggle with adherence. Simplifying regimens for these individuals may improve treatment outcomes and prevent drug resistance.
Area of Science:
- Neuroscience
- Infectious Diseases
- Pharmacology
Background:
- Highly active antiretroviral therapy (HAART) significantly improves HIV/AIDS outcomes.
- Patient adherence to HAART is crucial for viral suppression and preventing drug resistance.
- Non-adherence can lead to viral rebound and the emergence of resistant HIV strains.
Purpose of the Study:
- To investigate the predictive value of neuropsychological impairment and medication regimen complexity on HAART adherence in HIV-infected adults.
- To identify specific cognitive deficits associated with poor medication adherence.
- To explore the relationship between age and HAART adherence.
Main Methods:
- A convenience sample of 137 HIV-infected adults was studied.
- Medication adherence was objectively measured using electronic monitoring (MEMS caps).
- Neuropsychological assessments were conducted to evaluate cognitive function.
- Statistical analyses included two-way ANOVA and logistic regression.
Main Results:
- Neurocognitive compromise and complex medication regimens were independently associated with lower adherence rates.
- Individuals with both cognitive deficits and complex regimens exhibited the poorest adherence.
- Deficits in executive function, memory, and attention significantly predicted poor adherence.
- Neuropsychological impairment increased the risk of adherence failure by 2.3 times.
- Older age (>50 years) was linked to better adherence.
Conclusions:
- HIV-infected adults with significant neurocognitive impairment are at high risk for medication non-adherence, especially with complex HAART regimens.
- Simpler medication dosing schedules may enhance adherence in cognitively impaired patients.
- Tailoring HAART regimens based on cognitive status is essential for optimizing treatment efficacy.