Skip to main content

Advertisement

SpringerLink
Log in

Neurocognitive Aspects of Medication Adherence in HIV-Positive Injecting Drug Users

  • HIV Treatment Research Article
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Cognitive deficits are associated with nonadherence to HIV medications. HIV-positive injecting drug users (IDUs) are at particular risk for nonadherence and cognitive barriers to adherence specific to this population should therefore be identified. The present study assessed the relation of three domains of cognitive functioning, executive functions, memory, and psychomotor speed, to self-reported antiretroviral adherence in a sample of HIV-positive IDUs. Depression, use of alcohol, heroin, cocaine/crack, or marijuana in the last week were also included in the models. Logistic regression analyses showed that only psychomotor slowing was significantly associated with nonadherence. Executive functions, memory, depression, and active alcohol and substance use were unrelated to adherence. No other studies to date have exclusively linked psychomotor slowing to nonadherence in HIV infection. Psychomotor slowing among our study sample was severe and suggests that when evident, such slowing may be a valuable determinant for antiretroviral adherence among IDUs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Ahmad, S., Ahmad, H., and Bindra, G. (1989). Cognitive impairment in chronic heroin addicts. Journal of Personality and Clinical Studies, 5, 237–240.

    Google Scholar 

  • Albert, S. M., Weber, C. M., Todak, G., Polanco, C., Clouse,R., McElhiney, M., Rabkin, J., Stern, Y., Marder, K.(1999). An observed performance test of medication management ability in HIV: Relation to neuropsychological status and medication adherence outcomes. AIDS and Behavior, 3, 121–128.

    Article  Google Scholar 

  • Arnsten, J. H., Demas, P. A., Farzadegan, H., Grant, R. W., Gourevich, M. N., Chang, C., et al. (2001). Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: Comparison of self-report and electronic monitoring. Clinical Infectious Diseases, 33, 1417–1423.

    Article  PubMed  CAS  Google Scholar 

  • Arnsten, J. H., Demas, P. A., Grant, R. W., Gourevitch, M. N., Farzadegan, H., Howard, A. A., et al. (2002). Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. Journal of General Internal Medicine, 17, 377–381.

    Article  PubMed  Google Scholar 

  • Avants, S. K., Margolin, A., Warburton, L. A., Hawkins, K. A., and Shi, J. (2001). Predictors of nonadherence to HIV-related medication regimens during methadone stabilization. The American Journal on Addictions, 10, 69–78.

    Article  PubMed  CAS  Google Scholar 

  • Bangsberg, D. R., Hecht, F. M., Charlebois, E. D., Zolopa, A. R., Holodniy, M., Sheiner, L., et al. (2000). Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS, 14, 357–366.

    Article  PubMed  CAS  Google Scholar 

  • Basso, M. R., and Bornstein, R. A. (2000). Neurobehavioral consequences of substance abuse and HIV infection. Journal of Psychopharmacology, 14, 228–237.

    Article  PubMed  CAS  Google Scholar 

  • Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., and Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

    PubMed  CAS  Google Scholar 

  • Benton, A. L., Hamsher, K., and Sivan, A. B. (1983). Multilingual Aphasia Examination (3rd ed.). Iowa City, IA: AJA Associates.

    Google Scholar 

  • Berry, J., van Gorp, W. G., Herzberg, D. S., Hinkin, C., Boone, K., Steinman, L., et al. (1993). Neuropsychological deficits in abstinent cocaine abusers: Preliminary findings after two weeks of abstinence. Drug and Alcohol Dependence, 32, 231–237.

    Article  PubMed  CAS  Google Scholar 

  • Bono, G., Mauri, M., Sinforiani, E., Barbarini, G., Minoli, L., and Fea, M. (1996). Longitudinal neuropsychological evaluation of HIV-infected intravenous drug users. Addiction, 91, 263–268.

    Article  PubMed  CAS  Google Scholar 

  • Bornstein, R. A., Pace, P., Rosenberger, P., Nasrallah, H. A., Para, M. F., Whitacre, C. C., et al. (1993). Depression and neuropsychological performance in asymptomatic HIV infection. American Journal of Psychiatry, 150, 922–927.

    PubMed  CAS  Google Scholar 

  • Carrieri, M. P., Chesney, M. A., Spire, B., Loundou, A., Sobel, A., Lepeu, G., Moatti, J. P., and the MANIF Study Group. (2003). Failure to maintain adherence to HAART in a cohort of French HIV-positive injecting drug users. International Journal of Behavioral Medicine, 10, 1–14.

    Article  PubMed  CAS  Google Scholar 

  • Catz, S. L., Kelly, J. A., Bogart, L. M., Benotsch, E. G., and McAuliffe, T. L. (2000). Patterns, correlates and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychology, 19, 124–133.

    Article  PubMed  CAS  Google Scholar 

  • Cohen, R. A., Boland, R., Paul, R., Tashima, K. T., Schoenbaum, E. E., Celentano, D. D., et al. (2001). Neurocognitive performance enhanced by highly active antiretroviral therapy in HIV infected women. AIDS, 15, 341–345.

    Article  PubMed  CAS  Google Scholar 

  • Cummings, J. L., and Benson, D. F. (1992). Dementia: A clinical approach (2nd ed.). Boston: Butterworth Heinemann.

    Google Scholar 

  • The Dana Consortium. (1996). Clinical confirmation of the American Academy of Neurology algorithm for HIV-1-associated cognitive/motor disorder. The Dana Consortium on Therapy for HIV Dementia and Related Cognitive Disorders. Neurology, 47, 1247–1253.

    Google Scholar 

  • D’Elia, L., Satz, P., Uchiyama, C. L., and White, T. (1996). Color trails 1 and 2. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Ferrando, S., van Gorp, W., McElhiney, M., Goggin, K., Sewell, M., and Rabkin, J. (1998). Highly active antiretroviral treatment in HIV infection: Benefits for neuropsychological function. AIDS, 12, F65–F70.

    Article  PubMed  CAS  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., and Williams, J. B. (1995). Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition (Version 2.0). New York: New York State Psychiatric Institute.

    Google Scholar 

  • Galea, S., and Vlahov, D. (2002). Social determinants and the health of drug users: Socioeconomic status, homeless, and incarceration. Public Health Reports, 117, S135–S145.

    PubMed  Google Scholar 

  • Gordillo, V., del Amo, J., Soriano, V., and Gonzalez-Lahoz, J. (1999). Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS, 13, 1763–1769.

    Article  PubMed  CAS  Google Scholar 

  • Grant, I., Adams, K. M., Carlin, A. S., Rennick, P. M., Judd, L. L., Schooff, K., et al. (1978). Neuropsychological effects of polydrug abuse. In D. R. Wesson, A. S. Carlin, K. M. Adams, and G. Beschner (Eds.), Polydrug abuse. The results of a national collaborative study (pp. 223–261). New York: Academic.

    Google Scholar 

  • Grant, I., Atkinson, J. H., Hesselink, J. R., Kennedy, C. J., Richman, D. D., and Spector, S. A., et al. (1987). Evidence for early central nervous system involvement in the Acquired immunodeficiency virus (HIV) infections. Annals of Internal Medicine, 107, 828–836.

    PubMed  CAS  Google Scholar 

  • Grant, I., and Martin, A. (1994). Neurocognitive disorders associated with HIV-1 infection. In I. Grant and A. Martin (Eds.), Neuropsychology of HIV-1 infection (pp. 3–19). New York: Oxford University Press.

    Google Scholar 

  • Hinkin, C. H., Castellon, S. A., Durvasula, R. S., Hardy, D. J., Lam, M. N., and Mason, K. I., et al. (2002). Medication adherence among HIV+ adults. Neurology, 59, 1944–1950.

    PubMed  CAS  Google Scholar 

  • Hinkin, C. H., Hardy, D. J., Mason, K. I., Castellon, S. A., Durvasula, R. S., Lam, M. N., et al. (2004). Medication adherence in HIV-infected adults: Effect of patient, age, cognitive status, and substance abuse. AIDS, 18, S19–S25.

    Article  PubMed  Google Scholar 

  • Howard, A. A., Arnsten, J. H., Lo, Y., Vlahov, D., Rich, J. D., Schuman, P., Stone, V. E., Smith, D. K., Schoenbaum, E. E., and the HER Study Group. (2002). A prospective study of adherence and viral load in a large multi-center cohort of HIV-infected women. AIDS, 16, 2175–2182.

    Article  PubMed  CAS  Google Scholar 

  • Karon, J. M., Fleming, P. L., Steketee, R. W., and DeCock, K. M. (2001). HIV in the United States at the turn of the century. American Journal of Public Health, 91, 1060–1068.

    Article  PubMed  CAS  Google Scholar 

  • Liu, H., Golin, C. E., Miller, L. G., Hays, R. D., Beck, C. K., Sanadaji, S., et al. (2001). A comparison study of multiple measures of adherence to HIV protease inhibitors. Annals of Internal Medicine, 134, 968–977.

    PubMed  CAS  Google Scholar 

  • Lucas, G. M., Cheever, L. W., Chaisson, R. E., and Moore, R. D. (2001). Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection. Journal of Acquired Immune Deficiency Syndromes, 27, 251–259.

    PubMed  CAS  Google Scholar 

  • Mannheimer, S., Friedland, G., Matts, J., Child, C., and Chesney, M. (2002). The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus-infected persons in clinical trials. Clinical Infectious Diseases, 34, 1115–1121.

    Article  PubMed  Google Scholar 

  • Martens, W. H. (2001). A review of physical and mental health in homeless persons. Public Health Review, 29, 13–33.

    CAS  Google Scholar 

  • Meek, P. S., Clark, H. W., and Solana, V. L. (1989). Neurocognitive impairment: The unrecognized component of dual diagnoses in substance abuse treatment. Journal of Psychoactive Drugs, 21, 153–160.

    PubMed  CAS  Google Scholar 

  • Montaner, J. S. G., Reiss, P., Cooper, D., Vella, S., Harris, M., Conway, B., et al. (1998). A randomized, double-blind trial comparing combinations of nevirapine, didanosine and zidovudine for HIV-infected patients. JAMA, 279, 930–937.

    Article  PubMed  CAS  Google Scholar 

  • Murphy, E. L., Collier, A. C., Kalish, L. A., Assmann, S. F., Para, M. F., Flanigan, T. P., et al. (2001). Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease. Annals of Internal Medicince, 135, 17–26.

    CAS  Google Scholar 

  • Navia, B. A., Jordan, B. D., and Price, R. W. (1986). The AIDS dementia complex: I. Clinical features. Annals of Neurology, 19, 517–524.

    Article  PubMed  CAS  Google Scholar 

  • Paterson, D., Swindells, S., Mohr, J., Brestor, M., Vergis, R., Squier, C., et al. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133, 21–30.

    PubMed  CAS  Google Scholar 

  • Paterson, D. L., Potoski, B., and Capitano, B. (2002). Measurement of adherence to antiretroviral medications. Journal of Acquired Immune Deficiency Syndromes, 31, S103–S106.

    PubMed  Google Scholar 

  • Sacktor, N., McDermott, M. P., Marder, K., Schiffito, G., Selnes, O. A., McArthur, J. C., et al. (2002). HIV-associated cognitive impairment before and after the advent of combination therapy. Journal of Neurovirology, 8, 136–142.

    Article  PubMed  CAS  Google Scholar 

  • Sacktor, N., Skolasly, R. L., Tarwater, P. M., McArthur, J. C., Selnes, O. A., Becker, J., et al. (2003). Response to systemic HIV viral load suppression correlates with psychomotor speed performance. Neurology, 61, 567–569.

    PubMed  CAS  Google Scholar 

  • Sankoh, A. J., Huque, M. F., and Dubey, S. D. (1997). Some comments on frequently used multiple endpoint adjustments methods in clinical trials. Statistics in Medicine, 16, 2529–2542.

    Article  PubMed  CAS  Google Scholar 

  • Selnes, O. A., Galai, N., McArthur, J. C., Cohn, S., Royal, W., Esposito, D., et al. (1997). HIV infection and cognition in intravenous drug users: Long-term follow-up. Neurology, 48, 223–230.

    PubMed  CAS  Google Scholar 

  • Smith, A. (2000). Symbol Digit Modalities Test: Manual. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Stern, R. A., Silva, S. G., Chaisson, N., and Evans, D. L. (1996). Influence of cognitive reserve on neuropsychological functioning in asymptomatic human immunodeficiency virus-1 infection. Archives of Neurology, 53, 148–153.

    PubMed  CAS  Google Scholar 

  • Stevens, J. (1996). Applied Multivariate Statistics for the Social Sciences (3rd ed.). Mahwah, NJ: Erlbaum.

    Google Scholar 

  • Strickland, T. L., Miller, B. L., Kowell, A., and Stein, R. (1993). Neurobiology of cocaine-induced organic brain impairment: Contribution from functional neuroimaging. Neuropsychology Review, 8, 1–9.

    Article  Google Scholar 

  • Suarez, S., Baril, L., Stankoff, B., Khellaf, M., Dubois, B., Lubetzki, C., et al. (2001). Outcome of patients with HIV-1-related cognitive impairment on highly active antiretroviral therapy. AIDS, 15, 195–200.

    Article  PubMed  CAS  Google Scholar 

  • Tesoriero, J., French, T., Weiss, L., Waters, M., Finkelstein, R., and Agins, B. (2003). Stability of adherence to highly active antiretroviral therapy over time among clients enrolled in the treatment adherence demonstration project. JAIDS: Journal of the Acquired Immune Deficiency Syndromes, 33, 484–493.

    Google Scholar 

  • Tiffin, J. (1968). Purdue Pegboard: Examiner manual. Chicago: Science Research Associates.

    Google Scholar 

  • Tombaugh, T. N., Kozak, J., and Rees, L. (1996). Normative data for the controlled oral word association test. In O. Spreen and E. Strauss (Eds.), A compendium of neuropsychological tests: Administration, norms and commentary (2nd ed.). New York: Oxford.

    Google Scholar 

  • Tucker, J. S., Burnam, A., Sherbourne, C. D., Kung, F. Y., and Gifford, A. L. (2003). Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. The American Journal of Medicine, 114, 573–580.

    Article  PubMed  Google Scholar 

  • Turner, B. J., Laine, C., Cosler, L., and Hauck, W. W. (2003). Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users. Journal of General Internal Medicine, 18, 248–257.

    Article  PubMed  Google Scholar 

  • Wagner, G. J. (2002). Predictors of antiretroviral adherence as measured by self-report, electronic monitoring, and medication diaries. AIDS Patient Care and STDs, 16, 599–608.

    Article  PubMed  Google Scholar 

  • Wainberg, M. A., and Friedland, G. (1998). Public health implications of antiretroviral therapy and HIV drug resistance. JAMA, 279, 1977–1983.

    Article  PubMed  CAS  Google Scholar 

  • Wall, T. L., Sorensen, J. L., Batki, S. L., Delucchi, K. L., London, J. A., and Chesney, M. A. (1995). Adherence to zidovudine (AZT) among HIV-infected methadone patients: A pilot study of supervised therapy and dispensing compared to usual care. Drug and Alcohol Dependence, 37, 261–269.

    Article  PubMed  CAS  Google Scholar 

  • Wechsler, D. (1997). Wechsler adult intelligence scale Manual (3rd ed.). New York: The Psychological Corporation.

    Google Scholar 

  • Wilkie, F. L., Eisdorfer, C., Morgan, R., Loewenstein, D. A., and Szapocznik, J. (1990). Cognition in early human immunodeficiency virus infection. Archives of Neurology, 47, 433–440.

    PubMed  CAS  Google Scholar 

  • Wilkinson, G. S. (1993). The Wide Range Achievement Test Administration Manual (3rd ed.). Wilmington, DE: Wide Range.

    Google Scholar 

  • Yeudall, L. T., Fromm, D., Reddon, J. R., and Stefanyk, W. O. (1986). Normative data stratified by age and sex for 12 neuropsychological tests. Journal of Clinical Psychology, 42, 918–946.

    Article  Google Scholar 

Download references

ACKNOWLEDGMENTS

This research was supported by a Development Award from the Drug Abuse and AIDS Research Center (DAARC) at the University of Miami-School of Medicine, Department of Epidemiology, funded by NIDA P30 DA 13870. This study was also supported, in part, by research grants DA 12792 and DA 13550.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA

    Drenna Waldrop-Valverde, Raymond L. Ownby, Frances L. Wilkie, Alison Mack & Mahendra Kumar

  2. Department of Epidemiology, University of Miami Miller School of Medicine, Miami, Florida, USA

    Lisa Metsch

  3. Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, P.O. Box 016960 (M817), Miami, Florida, 33101, USA

    Drenna Waldrop-Valverde

Authors
  1. Drenna Waldrop-Valverde
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raymond L. Ownby
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frances L. Wilkie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alison Mack
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mahendra Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lisa Metsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Drenna Waldrop-Valverde.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Waldrop-Valverde, D., Ownby, R.L., Wilkie, F.L. et al. Neurocognitive Aspects of Medication Adherence in HIV-Positive Injecting Drug Users. AIDS Behav 10, 287–297 (2006). https://doi.org/10.1007/s10461-005-9062-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-005-9062-6

KEY WORDS:

Search

Navigation