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

Hinkin, Charles Ha,b; Hardy, David Ja; Mason, Karen Ia; Castellon, Steven Aa,b; Durvasula, Ramani Sc; Lam, Mona Na,b; Stefaniak, Martaa


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.

From the aDepartment of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; bPsychology Service, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA; and cDepartment of Psychology, California State University at Los Angeles, Los Angeles, CA, USA.

Correspondence to Charles H. Hinkin, PhD, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Room C8-747, Los Angeles, CA 90024, USA.

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© 2004 Lippincott Williams & Wilkins, Inc.