Predictors of Medication Adherence and Antiretroviral Resistance Among HIV-Infected Cocaine Abusers Although Highly Active Antiretroviral Therapy (HAART) has been shown to dramatically reduce morbidity and mortality among HIV- infected individuals, without rigorous medication adherence viral replication will ensue and antiretroviral resistant HIV mutations will arise. Among HIV+ patients, there is growing evidence that those especially likely to demonstrate poor adherence are those who evidence significant neuropsychological impairment and those who are cocaine abusing/dependent. Using a structural equation modeling approach, the proposed study will investigate the impact of cocaine abuse, neurocognitive dysfunction, psychiatric disorder, psychosocial factors, demographic characteristics, and medication regimen complexity on medication adherence in a multiethnic sample of HIV+ cocaine abusing patients. Adherence will be objectively determined by use of computerized Medication Event Monitoring System (MEMS) caps, pill counts, adherence questionnaires, and self-report.
Specific aims i nclude: (1) how cocaine abuse/dependence affects medication adherence in HIV+ individuals, and how this interacts with time other variables of interest; (2) whether cocaine abuse and pattern of adherence failure are associated with the development of antiretroviral resistant HIV mutations, as indexed through genotypic resistance assays; (3) the predictive relationship between medication adherence and factors such as neurocognition, psychiatric status, risk taking, medical decision making and other critical psychosocial and sociocultural factors; and (4) the development of a taxonomy of risk factors and protective factors that will reliably identify subtypes of adherers/non-aderers. These questions will be investigated by our multidisciplinary team in a diverse sample of 300 HIV+ cocaine abusing/dependent adults. A comprehensive battery of psychosocial measures and neuropsychological tests will be administered at baseline and subjects adherence to their prescribed medical regimen will be monitored on a monthly basis for 6 months with the MEMS caps methodology. A blood sample will also be taken at baseline and at study completion, and assayed to determine whether antiretroviral resistant HIV mutations develop. It is expected that results from this study will help to identify those dually diagnosed HIV+ patients that are especially likely to be non- adherent and to inform targets for interventions that will enhance treatment adherence in this high risk population.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA013799-03
Application #
6603197
Study Section
Special Emphasis Panel (ZRG1-AARR-8 (01))
Program Officer
Comolli, Jean C
Project Start
2001-07-05
Project End
2005-06-30
Budget Start
2003-07-01
Budget End
2004-06-30
Support Year
3
Fiscal Year
2003
Total Cost
$673,700
Indirect Cost
Name
University of California Los Angeles
Department
Psychiatry
Type
Schools of Medicine
DUNS #
092530369
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; Van Dyk, Kathleen; Thames, April D et al. (2016) HIV-transmission-related risk behavior in HIV+ African American men: Exploring biological, psychological, cognitive, and social factors. J HIV AIDS Soc Serv 15:299-318
Arentoft, Alyssa; Van Dyk, Kathleen; Thames, April D et al. (2016) Comparing the unmatched count technique and direct self-report for sensitive health-risk behaviors in HIV+ adults. AIDS Care 28:370-5
Arentsen, Timothy J; Panos, Stella; Thames, April D et al. (2016) Psychosocial Correlates of Medication Adherence among HIV-Positive, Cognitively Impaired Individuals. J HIV AIDS Soc Serv 15:404-416
Thaler, Nicholas S; Sayegh, Philip; Arentoft, Alyssa et al. (2015) Increased neurocognitive intra-individual variability is associated with declines in medication adherence in HIV-infected adults. Neuropsychology 29:919-25
Thaler, Nicholas S; Sayegh, Philip; Kim, Michelle S et al. (2015) Interactive effects of neurocognitive impairment and substance use on antiretroviral non-adherence in HIV disease. Arch Clin Neuropsychol 30:114-21
Panos, Stella E; Del Re, A C; Thames, April D et al. (2014) The impact of neurobehavioral features on medication adherence in HIV: evidence from longitudinal models. AIDS Care 26:79-86
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
Patel, Sapna M; Thames, April D; Arbid, Natalie et al. (2013) The aggregate effects of multiple comorbid risk factors on cognition among HIV-infected individuals. J Clin Exp Neuropsychol 35:421-34
Becker, Brian W; Thames, April D; Woo, Ellen et al. (2011) Longitudinal change in cognitive function and medication adherence in HIV-infected adults. AIDS Behav 15:1888-94

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