Medication adherence among HIV+ adults: effects of cognitive dysfunction and regimen complexity.

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.

Nucleus basalis injections of N-methyl-D-aspartate enhance memory of rats in the double Y-maze.

N-methyl-D-aspartate (NMDA) receptors have been implicated in learning and memory. Many findings show that NMDA receptor antagonists impair memory. Few studies, however, have investigated the role of NMDA receptor agonists in mnemonic function. The present study examined the effects of nucleus basalis magnocellularis (nbm) injections of NMDA on memory. Rats were trained in a two-component double Y-maze task consisting of a spatial discrimination and a delayed alternation. Rats (n = 7) were surgically implanted with bilateral cannulae in the nbm prior to maze training. Once trained, animals received bilateral nbm injections (0.5 microl) of saline (0.9%), NMDA (50, 75, and 100 ng/side), and the benzodiazepine receptor partial inverse agonist N-methyl-beta-carboline-3-carboxamide (FG 7142; 200 ng/side), in a counterbalanced order. During testing, delays (0, 30, 60 s) were introduced. Nbm FG 7142 or NMDA (50 ng/side) produced an improvement in the delayed alternation task. Results support the hypothesis that nbm NMDA receptors are involved in cognitive processes mediating memory.

Neuropsychological functioning in HIV-positive African-American women with a history of drug use.

This preliminary investigation examined neuropsychological performance in a sample of human immunodeficiency virus (HIV)-positive and HIV-negative African-American women with a history of drug use. The study population was comprised of 10 HIV-negative, 9 asymptomatic HIV-positive, 13 symptomatic HIV-positive, and 10 acquired immunodeficiency virus (AIDS) patients. A neuropsychological battery designed to assess attention, psychomotor processing, verbal memory, and visual memory was administered to participants. No evidence of HIV-related cognitive impairment was found in patients in the early stages of HIV infection. Multivariate analyses of variance revealed significant deficits in psychomotor processing and verbal recall in persons with AIDS. These individuals showed greater difficulty in tasks requiring maintained attention and performed poorly on measures of immediate and delayed verbal recall. In contrast, HIV status was not related to visual memory, verbal recognition, or the number of errors made during a verbal recall task. The pattern of cognitive deficits observed in persons with AIDS resembles that commonly associated with subcortical pathology. The cognitive deficits observed were not related to depression or recentness of drug use.