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HIV infection is associated with impairments in prospective memory (ProM), an aspect of episodic memory that refers to the ability to execute a future intention, such as remembering to take a medication at a specific time. The current study sought to examine the relationship between HIVassociated ProM impairment and the successful management of independent activities of daily living (IADLs). In a cohort of 66 HIV-infected individuals, ProM accounted for a significant proportion of variance in self-reported IADL dependence over and above that which was explained by retrospective memory and current affective distress. Analysis of component cognitive processes revealed that the relationship between HIV-associated ProM deficits and IADL dependence was driven by impaired cue detection and self-initiated intention retrieval. Results were not better explained by demographic factors, HIV disease severity, psychiatric comorbidity, or substance use. Collectively, these data support the potential incremental ecological validity of ProM as a predictor of dependence in IADLs among persons living with HIV infection. KeywordsHuman immunodeficiency virus; neuropsychological assessment; episodic memory; activities of daily living HIV-associated Prospective Memory Impairment Increases Risk of Dependence in Everyday FunctioningThe human immunodeficiency virus (HIV) crosses the blood-brain barrier and often leads to neuropathological changes (e.g., syncytia and synaptodendritic injury), which primarily affect the basal ganglia, frontal neocortex, hippocampus, and cerebral white matter (González-Scarano, & Martín-García, 2005 has improved systemic disease outcomes and diminished the incidence of frank dementia among persons infected with HIV, the prevalence of milder forms of HIV-associated neurocognitive impairment remains a significant public health problem (McArthur, 2004). The neurobehavioral syndrome of HIV infection is most consistent with dysregulation of frontostriato-thalamo-cortical circuits and is typically marked by mild-to-moderate bradyphrenia, bradykinesia, executive dysfunction, and deficits in episodic memory (e.g., Reger, Welsh, Razani, Martin, & Boone, 2002). As many as one-half of individuals with HIV-associated neurocognitive impairment experience problems independently managing their instrumental activities of daily living (IADLs; Heaton et al., 2004). Neuropsychological impairment contributes to decrements in medication management (e.g., Albert et al., 1999), automobile driving (Marcotte et al., 1999), and vocational functioning (e.g., van Gorp, Baerwald, Ferrando, McElhiney, & Rabkin, 1999), even after considering the effects of HIV disease severity and psychiatric distress (e.g., depression).Deficits in episodic memory are among the strongest neuropsychological predictors of IADL declines in HIV (e.g., Andrade et al., 2005;Benedict, Mezhir, Walsh, & Hewitt, 2000;Heaton et al., 1994;van Gorp et al., 2007). Episodic memory impairment is evident in approximately 50% of individuals infected with HIV (e.g...

Non-adherence to combination antiretroviral therapies (cART) is highly prevalent and significantly increases the risk of adverse HIV disease outcomes. The current study evaluated the hypothesis that prospective memory -a dissociable aspect of episodic memory describing the ability to execute a future intention -plays an important role in successful cART adherence. Seventy-nine individuals with HIV infection who were prescribed at least one antiretroviral medication underwent a comprehensive neuropsychological and neuromedical evaluation prior to completing a one-month observation of their cART adherence as measured by electronic medication monitoring. Nonadherent individuals (n = 31) demonstrated significantly poorer prospective memory functioning as compared to adherent persons (n = 48), particularly on an index of time-based ProM (i.e., elevated loss of time errors). Deficits in time-based prospective memory were independently predictive of cART non-adherence, even after considering the possible influence of established predictors of adherence, such as general cognitive impairment (e.g., retrospective learning and memory) and psychiatric comorbidity (e.g., depression). These findings extend a nascent literature showing that impairment in time-based prospective memory significantly increases the risk of medication nonadherence and therefore may guide the development of novel strategies for intervention.