Medication adherence among HIV+ adults

Effects of cognitive dysfunction and regimen complexity

Datos Bibliográficos

ID23326575
AutoresCharles H Hinkin (VA Greater Los Angeles Healthcare System), S A Castellon (From the Department of Psychiatry & Biobehavioral Sciences (Drs. Hinkin, Castellon, Hardy, Lam, Mason, and Thrasher, and M. Stefaniak), UCLA School of Medicine; VA Greater Los Angeles Health Care System (Drs. Hinkin, Castellon, Lam, and Goetz); Department of Psychology (Dr. Durvasula), California State University at Los Angeles; and Department of Medicine (Dr. Goetz), UCLA School of Medicine, Los Angeles, CA.), Ramani Durvasula (0009-0004-2389-9124, VA Greater Los Angeles Healthcare System), R S Durvasula (From the Department of Psychiatry & Biobehavioral Sciences (Drs. Hinkin, Castellon, Hardy, Lam, Mason, and Thrasher, and M. Stefaniak), UCLA School of Medicine; VA Greater Los Angeles Health Care System (Drs. Hinkin, Castellon, Lam, and Goetz); Department of Psychology (Dr. Durvasula), California State University at Los Angeles; and Department of Medicine (Dr. Goetz), UCLA School of Medicine, Los Angeles, CA.), David Hardy (0000-0001-5874-4377, VA Greater Los Angeles Healthcare System), D J Hardy (From the Department of Psychiatry & Biobehavioral Sciences (Drs. Hinkin, Castellon, Hardy, Lam, Mason, and Thrasher, and M. Stefaniak), UCLA School of Medicine; VA Greater Los Angeles Health Care System (Drs. Hinkin, Castellon, Lam, and Goetz); Department of Psychology (Dr. Durvasula), California State University at Los Angeles; and Department of Medicine (Dr. Goetz), UCLA School of Medicine, Los Angeles, CA.), M Lam (0009-0002-3999-5255, VA Greater Los Angeles Healthcare System), M N Lam (From the Department of Psychiatry & Biobehavioral Sciences (Drs. Hinkin, Castellon, Hardy, Lam, Mason, and Thrasher, and M. Stefaniak), UCLA School of Medicine; VA Greater Los Angeles Health Care System (Drs. Hinkin, Castellon, Lam, and Goetz); Department of Psychology (Dr. Durvasula), California State University at Los Angeles; and Department of Medicine (Dr. Goetz), UCLA School of Medicine, Los Angeles, CA.), Karen Mason (0000-0003-1894-8740, VA Greater Los Angeles Healthcare System), K I Mason (From the Department of Psychiatry & Biobehavioral Sciences (Drs. Hinkin, Castellon, Hardy, Lam, Mason, and Thrasher, and M. Stefaniak), UCLA School of Medicine; VA Greater Los Angeles Health Care System (Drs. Hinkin, Castellon, Lam, and Goetz); Department of Psychology (Dr. Durvasula), California State University at Los Angeles; and Department of Medicine (Dr. Goetz), UCLA School of Medicine, Los Angeles, CA.), D Thrasher (From the Department of Psychiatry & Biobehavioral Sciences (Drs. Hinkin, Castellon, Hardy, Lam, Mason, and Thrasher, and M. Stefaniak), UCLA School of Medicine; VA Greater Los Angeles Health Care System (Drs. Hinkin, Castellon, Lam, and Goetz); Department of Psychology (Dr. Durvasula), California State University at Los Angeles; and Department of Medicine (Dr. Goetz), UCLA School of Medicine, Los Angeles, CA.), Matthew Bidwell Goetz (0000-0003-4542-992X, VA Greater Los Angeles Healthcare System), M Stefaniak (From the Department of Psychiatry & Biobehavioral Sciences (Drs. Hinkin, Castellon, Hardy, Lam, Mason, and Thrasher, and M. Stefaniak), UCLA School of Medicine; VA Greater Los Angeles Health Care System (Drs. Hinkin, Castellon, Lam, and Goetz); Department of Psychology (Dr. Durvasula), California State University at Los Angeles; and Department of Medicine (Dr. Goetz), UCLA School of Medicine, Los Angeles, CA.)
Año2002
Volumen59
Número12
Páginas1944-1950
Fecha de publicación2002-12-24
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaNeurology (JOURNAL)
Identificadores de la revistaISSN: 0028-3878 • E-ISSN: 1526-632X
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1212/01.wnl.0000038347.48137.67
PMID12499488
OpenAlexW2109188618
IdiomaEN
Citas recibidas57
Referencias citadas39

BACKGROUND: Although the use of highly active antiretroviral therapy in the treatment of HIV infection has led to considerable improvement in morbidity and mortality, unless patients are adherent to their drug regimen (i.e., at least 90 to 95% of doses taken), viral replication may ensue and drug-resistant strains of the virus may emerge. METHODS: The authors studied the extent to which neuropsychological compromise and medication regimen complexity are predictive of poor adherence in a convenience sample of 137 HIV-infected adults. Medication adherence was tracked through the use of electronic monitoring technology (MEMS caps). RESULTS: Two-way analysis of variance revealed that neurocognitive compromise as well as complex medication regimens were associated with significantly lower adherence rates. Cognitively compromised participants on more complex regimens had the greatest difficulty with adherence. Deficits in executive function, memory, and attention were associated with poor adherence. Logistic regression analysis demonstrated that neuropsychological compromise was associated with a 2.3 times greater risk of adherence failure. Older age (>50 years) was also found to be associated with significantly better adherence. CONCLUSIONS: HIV-infected adults with significant neurocognitive compromise are at risk for poor medication adherence, particularly if they have been prescribed a complex dosing regimen. As such, simpler dosing schedules for more cognitively impaired patients might improve adherence.

Family medicine · Human immunodeficiency virus (HIV) · Medication adherence · HIV Research and Treatment · HIV-related health complications and treatments · HIV/AIDS Research and Interventions · Internal Medicine · Medicine