This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The spread of HIV/AIDS has raised many public health concerns as the number of people living with HIV/AIDS (PLWHA) reaches epidemic proportions. Consequently, there has been an increasing amount of research done examining methods of prevention of transmission of infection and increasing the life span of PLWHA. One identified way to reduce the mortality associated with HIV/AIDS and lower the transmission of the virus is to improve the availability of and adherence to antiretroviral medications (U.S. Department of Health and Human Services, 2000). However, in order to fulfill these goals, strict adherence to the treatment program is crucial. Adherence levels of less than eighty percent have been associated with a significant increase in the risk of treatment failures, progressive clinical deterioration, mortality and viral mutations (Flexner & Piscitelli, 2003). These viral mutations lead the HIV to become resistant to antiretroviral medication (Saag, 2003; Zolopa & D'Aquila, 2003). Multidrug resistant (MDR) strains are becoming a major problem in the effective management of HIV and the presence of drug resistant strains are on the rise even in treatment naive patients due to transmission and adaptive mutations (Levy, 1998; Saag, 2003; Unger, Kreuter & Rubsamen-Waigmann, 2000; Zolopa & D'Aquila, 2003). ALthough difficult to measure precisely, medication adherence levels in PLWHA have not typically been high. Several studies have found that adherence generally lies somewhere between twenty to eighty percent (Flexner & Piscitelli, 2003; Kirton, Talotta & Zwolski, 2001; Nichols et al. 2002). Some of the main reasons for this high level of nonadherence are the medication side effects, incompatibilities with food, inconvenience of the regimen, and simply forgetting to take the medications (Allardice 2002; Centers for Disease Control, 2002; Flexner & Piscitelli, 2003). The underlying causes of forgetfulness, however, have not been thoroughly studies clinically and little information exists on the correlation between this forgetfulness and neurological impairment. Neurological disorders, particularly those which affect cognitive function, pose a threat to the success of an antiretroviral medication regimen. The difficulty in concentration and the ensuring memory impairment associated with cognitive dysfunction make it difficult for patients to achieve optimal adherence(Kirton, Talotta, & Zwp;slo. 2001; Nichols et al. 2003). Estimates of the exact incidence of neurological dysfunction among PLWHA vary but are projected to be high, with dementia being the most common cause (Galicia et al. 2000; Kirton, Talotta & Zwolski, 2001; Morris 2003; Nichols et al. 2002). HIV-associated dementia (HAD) is a progressive neurological disorder in PLWHA with cognitive, motor and behavioral manifestations. Early signs of HAD include decreased attention span, decreased ability to perform tasks, and memory loss with psychomotor slowing occurring later in the disease process (Kirton, Talotta & Zwolski, 2001; Nichols et al. 2002). Behavioral changes might also be present and include apathy and other depressive affects (Kirton, Talotta & Zwolski, 2001). Due to the potential effects on the daily functioning of PLWHA, HAD must be studied more closely in the clinical setting to determine its contribution to the problem of nonadherence to medication. In order to examine HAD in relation to antiretroviral medication adherence, we propose to first measure the occurrence of HAD in an outpatient population through the use of a mental status instrument. The use of this instrument is intended solely for research purposes and not as a clinical diagnostic tool. Only a trained clinician can diagnose a patient with HAD. Next, we will determine the level of antiretroviral medication adherence in the population through the use of two adherence questionnaires. Lastly, in an effort to isolate HAD symptomology, we will administer a depression scale to rule out depression as a contributing factor to incomplete medication adherence.
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