Medication adherence among HIV+ adults - Effects of cognitive dysfunction and regimen complexity
Medication adherence among HIV+ adults - Effects of cognitive dysfunction and regimen complexity
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DOI：
10.1212/01.wnl.0000038347.48137.67
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发表时间：
2002-12-24
期刊：
影响因子：
9.9
通讯作者：
Stefaniak, M
中科院分区：
文献类型：
--
作者：
Hinkin, CH;Castellon, SA;Stefaniak, M
工作背景：尽管在治疗HIV感染中使用高效抗逆转录病毒疗法已导致发病率和死亡率的显著改善，但除非患者遵守其药物方案（即，至少90%至95%的剂量），病毒复制可能随之发生，并可能出现耐药病毒株。研究方法：作者研究了神经心理学损害和药物治疗方案复杂性在多大程度上预测了137名HIV感染成年人的便利样本中的依从性差。通过使用电子监测技术（MEMS帽）跟踪药物依从性。结果如下：双向方差分析显示，神经认知损害以及复杂的药物治疗方案与依从率显着降低。认知受损的参与者接受更复杂的治疗方案，在坚持治疗方面遇到的困难最大。执行功能、记忆力和注意力的缺陷与依从性差有关。Logistic回归分析表明，神经心理学损害与依从性失败的风险增加2.3倍相关。年龄较大（>50岁）也与更好的依从性相关。结论：具有显著神经认知损害的HIV感染的成年人存在药物依从性差的风险，特别是如果他们已经被规定了复杂的给药方案。因此，对于认知受损更严重的患者，更简单的给药方案可能会提高依从性。
Background: Although the use of highly active antiretroviral therapy in the treatment of HIV infection has led to considerable improvement in morbidity and mortality, unless patients are adherent to their drug regimen (i.e., at least 90 to 95% of doses taken), viral replication may ensue and drug-resistant strains of the virus may emerge. Methods: The authors studied the extent to which neuropsychological compromise and medication regimen complexity are predictive of poor adherence in a convenience sample of 137 HIV-infected adults. Medication adherence was tracked through the use of electronic monitoring technology (MEMS caps). Results: Two-way analysis of variance revealed that neurocognitive compromise as well as complex medication regimens were associated with significantly lower adherence rates. Cognitively compromised participants on more complex regimens had the greatest difficulty with adherence. Deficits in executive function, memory, and attention were associated with poor adherence. Logistic regression analysis demonstrated that neuropsychological compromise was associated with a 2.3 times greater risk of adherence failure. Older age (>50 years) was also found to be associated with significantly better adherence. Conclusions: HIV-infected adults with significant neurocognitive compromise are at risk for poor medication adherence, particularly if they have been prescribed a complex dosing regimen. As such, simpler dosing schedules for more cognitively impaired patients might improve adherence.