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Medication adherence among HIV+ adults

Effects of cognitive dysfunction and regimen complexity

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.

Address correspondence and reprint requests to Dr. Charles H. Hinkin, UCLA School of Medicine, 760 Westwood Plaza, Room C8-747, Los Angeles, CA 90024; e-mail: chinkin{at}ucla.edu

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.

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