Document Detail


Relationships among neurocognitive status, medication adherence measured by pharmacy refill records, and virologic suppression in HIV-infected persons.
MedLine Citation:
PMID:  23202813     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Optimal antiretroviral therapy (ART) effectiveness depends on medication adherence, which is a complex behavior with many contributing factors, including neurocognitive function. Pharmacy refill records offer a promising and practical tool to assess adherence.
METHODS: A substudy of the CHARTER (CNS HIV Anti-Retroviral Therapy Effects Research) study was conducted at the Johns Hopkins University (JHU) and the University of Washington. Pharmacy refill records were the primary method to measure ART adherence, indexed to a "sentinel" drug with the highest central nervous system penetration-effectiveness score. Standardized neuromedical, neuropsychological, psychiatric, and substance use assessments were performed at enrollment and at 6 months. Regression models were used to determine factors associated with adherence and relationships between adherence and changes in plasma and cerebrospinal fluid HIV RNA concentrations between visits.
RESULTS: Among 80 (33 at JHU and 47 at University of Washington) participants, the mean adherence score was 86.4%, with no difference between sites. In the final multivariable model, better neurocognitive function was associated with better adherence, especially among participants who were at JHU, male, and HIV infected for a longer period of time. Worse performance in working memory tests was associated with worse adherence. Better adherence predicted greater decreases in cerebrospinal fluid HIV RNA between visits.
CONCLUSIONS: Poorer global neurocognitive functioning and deficits in working memory were associated with lower adherence defined by a pharmacy refill record measure, suggesting that assessments of cognitive function, and working memory in particular, may identify patients at risk for poor ART adherence who would benefit from adherence support.
Authors:
Adriana S A Andrade; Reena Deutsch; Shivaun A Celano; Nichole A Duarte; Thomas D Marcotte; Anya Umlauf; J Hampton Atkinson; J Allen McCutchan; Donald Franklin; Terry J Alexander; Justin C McArthur; Christina Marra; Igor Grant; Ann C Collier
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  62     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-08-08     Completed Date:  2013-08-20     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  282-92     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
Adult
Anti-HIV Agents / administration & dosage*,  therapeutic use
Cognition* / physiology
Community Pharmacy Services / statistics & numerical data
Female
HIV Infections / drug therapy*,  virology
Humans
Longitudinal Studies
Male
Medication Adherence / psychology,  statistics & numerical data*
Memory / drug effects
Middle Aged
Neuropsychological Tests
Regression Analysis
Risk Factors
Viral Load
Grant Support
ID/Acronym/Agency:
N01 MH022005/MH/NIMH NIH HHS; N01 MH22005/MH/NIMH NIH HHS
Chemical
Reg. No./Substance:
0/Anti-HIV Agents
Comments/Corrections

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