Relationships among neurocognitive status, medication adherence measured by pharmacy refill records, and virologic suppression in HIV-infected persons.
Relationships among neurocognitive status, medication adherence measured by pharmacy refill records, and virologic suppression in HIV-infected persons.
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DOI：
10.1097/qai.0b013e31827ed678
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发表时间：
2013-03-01
期刊：
影响因子：
--
通讯作者：
Collier AC
中科院分区：
文献类型：
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作者：
Andrade AS;Deutsch R;A Celano S;Duarte NA;Marcotte TD;Umlauf A;Atkinson JH;McCutchan JA;Franklin D;Alexander TJ;McArthur JC;Marra C;Grant I;Collier AC
抗逆转录病毒治疗 (ART) 的最佳效果取决于药物依从性，这是一种复杂的行为，涉及许多因素，包括神经认知功能。药房续药记录为评估依从性提供了一种有前途且实用的工具。约翰·霍普金斯大学 (JHU) 和华盛顿大学 (UW) 进行了 CHARTER（CNS HIV 抗逆转录病毒治疗效果研究）研究的子研究。药房补充记录是衡量 ART 依从性的主要方法，以中枢神经系统渗透有效性得分最高的“哨兵”药物为索引。在入组时和 6 个月时进行标准化神经医学、神经心理学、精神病学和物质使用评估。回归模型用于确定与依从性相关的因素以及依从性与就诊期间血浆和脑脊液 HIV RNA 浓度变化之间的关系。在 80 名（33 名约翰霍普金斯大学，47 名华盛顿大学）参与者中，平均遵守分数为 86.4%，各地点没有差异。在最终的多变量模型中，更好的神经认知功能与更好的依从性相关，尤其是在约翰霍普金斯大学、男性和艾滋病毒感染时间较长的参与者中。工作记忆测试的较差表现与较差的依从性相关。更好的依从性预示着两次就诊之间脑脊液 HIV RNA 的更大减少。较差的整体神经认知功能和工作记忆缺陷与药房补充记录测量所定义的较低依从性相关，这表明对认知功能（特别是工作记忆）的评估可能会识别出存在 ART 依从性较差风险的患者，这些患者将从依从性支持中受益。
Optimal antiretroviral therapy (ART) effectiveness depends upon medication adherence, which is a complex behavior with many contributing factors including neurocognitive function. Pharmacy refill records offer a promising and practical tool to assess adherence. A substudy of the CHARTER (CNS HIV Anti-Retroviral Therapy Effects Research) study was conducted at the Johns Hopkins University (JHU) and the University of Washington (UW). Pharmacy refill records were the primary method to measure ART adherence, indexed to a “sentinel” drug with the highest central nervous system penetration effectiveness score. Standardized neuromedical, neuropsychological, psychiatric and substance use assessments were performed at enrollment and at 6 months. Regression models were used to determine factors associated with adherence and the relationships between adherence and change in plasma and cerebrospinal fluid HIV RNA concentrations between visits. Among 80 (33 JHU, 47 UW) participants, the mean adherence score was 86.4% with no difference by site. In the final multivariable model, better neurocognitive function was associated with better adherence, especially among participants who were at JHU, male, and HIV-infected for a longer time-period. Worse performance on working memory tests was associated with worse adherence. Better adherence predicted greater decreases in cerebrospinal fluid HIV RNA between visits. Poorer global neurocognitive functioning and deficits in working memory were associated with lower adherence defined by a pharmacy refill record measure, suggesting that assessments of cognitive function, and working memory in particular, may identify patients at risk for poor ART adherence who would benefit from adherence support.