Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse

By C. Hinkin, D. Hardy, K. Mason, S. Castellon, R. Durvasula, M. Lam, M. Stefaniak. AIDS (London), 2004

631 citations recorded by the source corpus.

Objective: To examine the predictors of antiretroviral adherence among HIV-infected adults, with a particular focus on advancing age, neuropsychological dysfunction, and substance abuse. Design: Prospective observational design. Methods: Participants were 148 HIV-infected adults between the ages of 25 and 69 years, all on a self-administered antiretroviral regimen. Medication adherence was tracked over a one-month period using an electronic monitoring device (medication event monitoring system caps). All participants completed a comprehensive battery of neuropsychological tests as well as a structured psychiatric interview. Results: The mean adherence rate for the entire cohort was 80.7%, with older patients (⩾ 50 years) demonstrating significantly better medication adherence than younger patients (87.5 versus 78.3%). Logistic regression analyses found that older patients were three times more likely to be classified as good adherers (defined as ⩾ 95% adherent). Neurocognitive impairment conferred a 2.5 times greater risk of poor adherence. Among the older patients, those who were classified as poor adherers performed significantly worse on neuropsychological testing, particularly on measures of executive function and psychomotor speed. Current drug abuse/dependence, but not current alcohol abuse/dependence, was also associated with sub-optimal medication adherence. Conclusion: Although older age is associated with higher rates of antiretroviral adherence, older participants who were cognitively impaired showed disproportionate difficulty in adequately adhering to their medication regimen. As such, efforts to detect neuropsychological dysfunction, particularly among older patients, and a thorough assessment of substance abuse, appear to be essential for the effective treatment of HIV-infected adults.

Subfields: Emergency Medicine, Infectious Diseases, Virology

View Paper: https://www.semanticscholar.org/paper/a55954e1f25794a5e66e920330ad662272a8a408

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

R. Heaton
T. Marcotte
D. Franklin
Christine Fennema-Notestine
S. Woods
Ronald J Ellis
J. McCutchan
D. Clifford

Citations in the corpus

HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors (2010, background): “…mortality, independent of medical predictors (Ellis et al. 1997a; Mayeux et al. 1993), and often interferes significantly with cognitively demanding activities of daily living (e.g., employment, medication management, driving; Heaton et al. 2004b; Hinkin et al. 2004; Marcotte et al. 1999, 2004).”
The impact of HIV-associated neuropsychological impairment on everyday functioning (2004, positive): “For example, those with adequate abilities to follow a complex medication regimen may fail to do so consistently because of temporary interference from substance use disorders (Hinkin et al., 2004), or even inadequate motivation due to failure to believe that carefully following prescribed methods w”