The introduction of protease inhibitors has led to considerable optimism among patients and providers alike, but it has been shown that unless patients strictly adhere to their medication regimen, viral replication will increase and protease inhibitor--resistant viral mutations will arise. It is therefore of the utmost importance that the causes of non-adherence be identified and eradicated. One potential cause of non-adherence, particularly in older HIV+ patient, which has yet to be adequately addressed, is neuropsychological dysfunction. The primary aim of this study is to determine the effects of neuropsychological impairment, particularly memory deficits (prospective, retrospective, and working), dual task/executive dysfunction, and depression/apathy on HIV+ patients; adherence with their protease inhibitor regimen. A corollary aim is to ascertain how older age potentiates the deleterious effects of HIV- associated cognitive decline on adherence. The secondary aim is to determine the independent and interactive effects of advancing age and HIV infection on neurocognitive and neuropsychiatric function. The central hypothesis of the study is that HIV-associated cognitive impairment will lead to poor treatment adherence and that relationship will be magnified in older patient. Methods: 200 HIV seropositive participants (1/2 over age 50 years) will be administrated: (1) a battery of neuropsychological tests (both computerized measures of formation processing and clinical measures of memory and executive function) that have been chosen because of their hypothesized sensitivity to the effects of HIV infection and the normal aging process; (2) Measures of psychological function; and (3) Measures of health beliefs, intentions and related constructs which have been shown to predict adherence. The HIV+ participants; adherence to protease inhibitors will then be monitored for 3 months. Medication Event Monitoring System (MEMS) caps, which employ a microprocessor to automatically record the date and time each dose is taken will be the """"""""gold standard"""""""" for indexing adherence. Given the multi-determined nature of adherence as well as the complex data set this study will yield structural equation modeling using EQS will be the primary analytic strategy employed. Increased understanding as to how neuropsychological dysfunction impacts on treatment adherence, particularly among older HIV+ patients, is of critical importance given the personal and public health consequences of non-adherence.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH058552-02
Application #
2883475
Study Section
Psychobiological, Biological, and Neurosciences Subcommittee (MHAI)
Program Officer
Rausch, Dianne M
Project Start
1998-05-01
Project End
2003-02-28
Budget Start
1999-03-01
Budget End
2000-02-29
Support Year
2
Fiscal Year
1999
Total Cost
Indirect Cost
Name
University of California Los Angeles
Department
Psychiatry
Type
Schools of Medicine
DUNS #
119132785
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Sayegh, Philip; Thaler, Nicholas S; Arentoft, Alyssa et al. (2016) Medication Adherence in HIV-Positive African Americans: The Roles of Age, Health Beliefs, and Sensation Seeking. Cogent Psychol 3:
Arentoft, Alyssa; Thames, April D; Panos, Stella et al. (2013) A deconstruction of gambling task performance among HIV+ individuals: the differential contributions of problem solving and risk taking. J Clin Exp Neuropsychol 35:1036-47
Thames, April D; Moizel, Jennifer; Panos, Stella E et al. (2012) Differential predictors of medication adherence in HIV: findings from a sample of African American and Caucasian HIV-positive drug-using adults. AIDS Patient Care STDS 26:621-30
Wright, Matthew J; Woo, Ellen; Foley, Jessica et al. (2011) Antiretroviral adherence and the nature of HIV-associated verbal memory impairment. J Neuropsychiatry Clin Neurosci 23:324-31
Foley, J M; Wright, M J; Gooding, A L et al. (2011) Operationalization of the updated diagnostic algorithm for classifying HIV-related cognitive impairment and dementia. Int Psychogeriatr 23:835-43
Foley, Jessica; Ettenhofer, Mark; Wright, Matthew J et al. (2010) Neurocognitive functioning in HIV-1 infection: effects of cerebrovascular risk factors and age. Clin Neuropsychol 24:265-85
Ettenhofer, Mark L; Hinkin, Charles H; Castellon, Steven A et al. (2009) Aging, neurocognition, and medication adherence in HIV infection. Am J Geriatr Psychiatry 17:281-90
Wright, Matthew J; Woo, Ellen; Schmitter-Edgecombe, Maureen et al. (2009) The Item-Specific Deficit Approach to evaluating verbal memory dysfunction: rationale, psychometrics, and application. J Clin Exp Neuropsychol 31:790-802
Gorman, Ashley A; Foley, Jessica M; Ettenhofer, Mark L et al. (2009) Functional consequences of HIV-associated neuropsychological impairment. Neuropsychol Rev 19:186-203
Hardy, David J; Castellon, Steven A; Hinkin, Charles H et al. (2008) Sensation seeking and visual selective attention in adults with HIV/AIDS. AIDS Behav 12:930-4

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