People with cognitive impairment have poorer adherence to HIV therapy, need easy dosing

Michael Carter
Estimated reading time 3 minutes
This article is more than 22 years old.

HIV-positive people who have problems remembering, learning or understanding as a result of their illness are less likely to adhere to their HAART regimen than HIV patients with normal cognitive function, according to a US study published in the 24th December edition of the journal Neurology.

Investigators in Los Angeles recruited a sample of 137 HIV-positive patients who were taking HAART. Neurological tests indicated that 34% of the sample were cognitively impaired. The investigators defined adherence as taking 95% of HAART doses at the right time, an established cut-off point for effective HAART. Computer chips were embedded in the caps of medicine bottles to record the date, time and duration of opening.

When adherence levels were compared between patients with normal cognitive function and those with impairment it was found that, on average, those with cognitive impairment adhered 70% of the time, compared to 82% adherence in the unimpaired group.

Glossary

sample

Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).

cognitive impairment

Loss of the ability to process, learn, and remember information. Potential causes include alcohol or drug abuse, depression, anxiety, vascular cognitive impairment, Alzheimer’s disease and HIV-associated neurocognitive disorder (HAND). 

neurological

Relating to the brain or central nervous system.

dementia

Loss of the ability to process, learn, and remember information. Potential causes include alcohol or drug abuse, depression, anxiety, vascular cognitive impairment, Alzheimer’s disease and HIV-associated neurocognitive disorder (HAND). 

acute infection

The very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).

Adherence was particularly low amongst cognitively impaired patients taking three doses a day (52%), compared to 78% adherence in other patients. For patients taking once or twice daily therapy, cognitively impaired patients managed adherence of 78% compared to 84% in unimpaired patients.

However, patients aged over 50 were three times more likely to take their medication correctly, whether or not they were assessed as having any form of cognitive problems. Investigators also stress that whilst cognitive impairment was associated with poorer adherence, other factors are also important, including ?drug and alcohol abuse, psychiatric illness, and lack of ready access to health care.?

Comment

Neither the patients with impaired or normal cognitive function managed to achieve optimum levels of adherence in this study, and a comparison with cognitively impaired patients taking medication for other acute or chronic illness would have been interesting.

HIV medication does require particularly high levels of adherence, and the fact that the study finds that 70% of people, even if they have memory problems, are able to achieve the required adherence makes is an indicator of the high level of commitment that exists amongst many patients on HAART. Hopefully, even higher levels of adherence can be achieved with comprehensive support and intervention to address not only cognitive problems but the other life issues indicated by the study. A NAM booklet on adherence in the Information for HIV-positive People series will be published in January/February 2003.

Draft BHIVA/MSSVD guidelines on adherence support are available on this website. Click here for details.

Further Information on this website

Adherence - overview

Memory problems

HIV-associated dementia

References

Hinkin CH et al Medication adherence in among HIV-positive adults: effects of cognitive dysfunction and regimen complexity Neurology, 59: 1944-1949, 2002

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