The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus

Abstract

BackgroundAsymptomatic cognitive impairment in human immunodeficiency virus (HIV)-infected patients has recently been recognised as part of HIV-associated neurocognitive disorders. This has been implicated as one of the causes of poor adherence to antiretroviral therapy (ART).ObjectiveTo assess the association between neurocognitive impairment (asymptomatic and mild forms) and adherence to ART.MethodsThis was a cross-sectional survey involving 218 participants consecutively sampled from those attending the HIV treatment clinic at Aga Khan University Hospital in Nairobi. Data collected included quantitative primary data on pre-defined baseline characteristics, neurocognitive assessment by Montreal Cognitive Assessment (MoCA) tool (Appendix 1), instrumental activities of daily living by Lawton score and objective and subjective adherence measures by medication possession ratio (MPR) and simplified medication adherence questionnaire (SMAQ) (see Appendix 2). Univariate and bivariate analyses were conducted to determine the strengths of association between predictor and the outcome variables.ResultsAmong the 218 participants in the study, a total of 69% had asymptomatic to mild neurocognitive impairment as assessed by the MoCA tool, while a total of 66% were determined as being adherent to ART by objective measures (by MPR) compared to subjective rates of 77% as assessed by SMAQ. However, no statistically significant association was observed between the presence of asymptomatic or mild neurocognitive impairment and likelihood of adherence to ART (p > 0.05).ConclusionEven though asymptomatic and mild forms of cognitive impairment are prevalent in the population studied, there was no significant association between cognitive impairment and adherence to treatment.

Montreal Cognitive Assessment (MoCA) scores in medically compromised patients: A scoping review.

“…Bourgeois et al (2020) examined associations among demographic and functional factors and MoCA scores in a cross-sectional study ( N = 359, M age = 45) and found lower MoCA scores were associated with worse performance on the four-minute walk test (4-MWT). Only Awori and colleagues (2018) found that MoCA scores were not significantly associated with outcome variables in their population ( N = 215, M age = 45), including viral load and medication adherence. Overall, poorer MoCA performance in individuals with HIV may signal cognitive impairment, which could pose risk for poorer outcomes due to lower adherence to medication regimens and thus increased disease burden, physical comorbidities, and/or reduced performance on tasks of everyday functioning.…”

“…Three of four studies reviewed found significant associations among MoCA scores and functional health or outcome variables in populations with HIV. Presence of impairment on the MoCA ranged from 25% to 35% (Awori et al, 2018; Bourgeois et al, 2020; Fazeli et al, 2017) to as high as 73% (Shahani et al, 2018). Shahani and colleagues (2018) found in their prospective study ( N = 138, M age = 36) that MoCA scores < 26 were associated with an odds ratio ( OR ) of 2.70 (95% CI: 1.09–6.69) for virologic failure.…”

Posttraumatic Stress Disorder and Nonadherence to Treatment in People Living With HIV: A Systematic Review and Meta-analysis

“…Underlying the relationship between PTSD and ART adherence in PLWH relates to cognitive impairments and PTSD symptoms. PLWH may already have potential impairment in multi-cognitive domains that have been linked to ART non-adherence ( 36 ). Specifically, PLWH is profoundly associated with prospective memory deficit which is a strong risk of concurrent problems ranging from medication non-adherence to employment ( 31 ).…”

Reliability, validity and measurement invariance of the Simplified Medication Adherence Questionnaire (SMAQ) among HIV-positive women in Ethiopia: a quasi-experimental study

“…It was developed and validated among a sample of predominantly male (72%) HIV-positive individuals in Spain, with 72% sensitivity, 91% specificity, and a likelihood ratio of 7.9 in identifying nonadherent patients as compared to medication event monitoring systems, the authors concluded that the SMAQ was reliable and valid for assessment of adherence among HIV-infected patients in most settings [21]. It has been used to assess adherence to ART in at least 12 countries, including South Africa and Kenya, in at least 25 studies and interventions between 2002 and 2018 [22][23][24][25][26][27][28][29][30][31][20][21][22][23][24][25]. It has also been used to assess adherence to non-HIV medication in at least eight countries and 12 studies [32][33][34][35][36][37][38][39][40][41].…”