COGNITIVE DEFICITS AND MEDICATION ADHERENCE IN HIV/AIDS

说明（申请人摘要）：蛋白酶的引入 抑制剂已经导致患者和供应商相当乐观 同样，但已经表明，除非患者严格遵守 他们的药物治疗方案，病毒复制将增加和蛋白酶 抑制剂抗性病毒突变将会出现。 因此， 最重要的是查明不遵守的原因， 被消灭了 不依从的一个潜在原因，特别是在老年人中 艾滋病毒阳性患者尚未得到充分解决， 神经心理功能障碍 本研究的主要目的是 确定神经心理障碍的影响，特别是 记忆缺陷（前瞻性、回顾性和工作性），双重 任务/执行功能障碍和抑郁/冷漠; 坚持他们的蛋白酶抑制剂方案。 一个必然的目标是 确定老年如何增强艾滋病毒的有害影响- 相关认知下降的影响。 第二个目标是 确定年龄增长的独立和相互影响， HIV感染对神经认知和神经精神功能的影响 的 这项研究的中心假设是， 损伤将导致较差治疗依从性， 在老年患者中会被放大。 方法：200例HIV阳性者 参与者（1/2年龄超过50岁）将被给予：（1）a 神经心理学测试（包括计算机测量） 记忆和执行的形成过程和临床测量 功能），因为它们的假设 对艾滋病毒感染和正常衰老的影响的敏感性 （2）心理功能的测量;（3） 健康信念，意图和相关的结构， 来预测依从性。 HIV+参与者;坚持使用蛋白酶 然后监测抑制剂3个月。 药物处理事件 监测系统（MEMS）帽，采用微处理器， 自动记录每次服药的日期和时间， “黄金标准”的索引坚持。 鉴于多重决定 依从性的性质以及本研究的复杂数据集将 产量结构方程模型将主要使用EQS 采用的分析策略。 更好地理解如何 神经心理功能障碍影响治疗依从性， 特别是在老年艾滋病毒+患者中， 不遵守的个人和公共健康后果。

DESCRIPTION (Applicant's Abstract): 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.