The impact of neurobehavioral features on medication adherence in HIV: Evidence from longitudinal models

Abstract

Effective antiretroviral therapy has led to substantial improvements in health-related outcomes among individuals with HIV. Despite advances in HIV pharmacotherapy, suboptimal medication adherence remains a significant barrier to successful treatment. Although several factors have been associated with medication adherence in the extant literature, study assessing the effects of some of the neurobehavioral features specific to HIV has been limited. Moreover, although there is a growing body of literature measuring medication adherence in HIV prospectively, few employ advanced statistical methodologies suited to handle advanced models with multiple predictors that would strengthen our understanding of medication adherence trajectories in HIV. This study sought to integrate traditionally assessed predictors of medication adherence with neurobehavioral features of HIV in a longitudinal study of medication adherence to combined antiretroviral therapy (cART). The current study used multilevel modeling to examine a wide arrangement of categories of factors - demographic, medication related, psychosocial, and neurobehavioral - on medication adherence. The sample consisted of 235 HIV + individuals whose medication adherence was monitored over the course of six months using electronic monitoring devices. After controlling for the effects of demographic, medication, and psychosocial factors, neurobehavioral features added predictive validity to the model. In the final model, simultaneously controlling for the effects of each of the predictors within all the categories, age, self-efficacy, executive functioning, apathy, and frequency of stimulant use emerged as unique individual predictors of average medication adherence across the 6-month study. Self-efficacy and irritability predicted changes in medication adherence over time. Adherence behavior is multidetermined. Adequate assessment of these factors, combined with timely intervention, appears to be warranted in order to boost adherence rates.

High early life stress and aberrant amygdala activity: risk factors for elevated neuropsychiatric symptoms in HIV+ adults

“…Moreover, neuropsychiatric disorders have a negative effect on critical HIV-disease outcomes (e.g., medication adherence) and have been linked to increased HIV-related mortality rates (Antelman et al 2007; Catz et al 2000; Cook et al 2002; Horberg et al 2008; Ickovics et al 2001; Leserman 2008; Marshall et al 2013; Mayne et al 1996; Panos et al 2014; Safren et al 2001). Gaining a better understanding of the neural substrates of these highly prevalent disorders could stimulate improvements in diagnostic, preventative, and treatment strategies available to HIV+ adults, which in turn would improve both quality of life and health outcomes in this population.…”

Psychosocial correlates of medication adherence among HIV-positive, cognitively impaired individuals

“…Future attention may also focus on the relationship between adherence and the quality of family / social support for this population, which was not fully assessed within the current study. Additionally, previous research employing MEMS cap data have suggested that this technique may underestimate actual adherence rates to some extent (Lui et al, 2001; Panos et al, 2013), especially for individuals with poor cognitive functioning (Levine et al, 2006). The current study sought to control for potential underestimates by directly instructing participants against pocket-dosing medication (i.e., removing medication from the bottle to take at a later time) and through repeated follow-up appointments to encourage MEMS bottle use.…”

“…Cognitive impairment has repeatedly been shown to adversely affect adherence (Becker, Thames, Woo, Castellon, & Hinkin, 2011; Ettenhofer, Foley, Castellon, & Hinkin, 2010; Ezeabogu, Copenhaver, & Potrepka, 2012; Hinkin et al, 2002; Hinkin et al, 2004; Panos et al, 2013). For example, Hinkin et al (2004) found that HIV+ individuals with cognitive dysfunction were 2.5 times more likely to be poor adherers to their antiretroviral therapy regimen.…”

Cannabis Use, Medication Management and Adherence Among Persons Living with HIV

“…Neurocognitive functioning is known to be affected by HIV (26–28) and has been associated with medication adherence and management (25, 29–31). There have been reports of negative correlations between medication management and attention/working memory, executive function, learning, and memory (25).…”