COGNITIVE DEFICITS AND MEDICATION ADHERENCE IN HIV/AIDS

HIV/艾滋病患者的认知缺陷和药物依从性

• 批准号: 6228984
• 负责人: CHARLES H HINKIN
• 金额: $ 13.33万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-05-01 至 2003-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6228984
• 关键词: AIDS dementia complex; AIDS therapy; adult human (21+); aging; clinical research; human subject; mathematical model; model design /development; neuropsychological tests; patient monitoring device; protease inhibitor; therapy compliance

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.

描述（申请人摘要）：蛋白酶的介绍 抑制剂让患者和医疗服务提供者抱有相当大的乐观情绪 相似，但事实证明，除非患者严格遵守 他们的药物治疗方案，病毒复制会增加，蛋白酶 将会出现对抑制剂具有抗性的病毒突变。 因此它是 最重要的是查明不遵守规定的原因并 根除。 不依从的潜在原因之一，尤其是老年人 HIV+ 患者这一问题尚未得到充分解决， 神经心理功能障碍。 这项研究的主要目的是 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 HIV+ 患者的任务/执行功能障碍和抑郁/冷漠； 坚持蛋白酶抑制剂治疗方案。 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 与依从性相关的认知能力下降。 次要目标是 确定年龄增长的独立影响和交互影响 HIV 感染对神经认知和神经精神功能的影响。 这 该研究的中心假设是与艾滋病毒相关的认知 损害将导致治疗依从性差，并且这种关系 在老年患者中会被放大。 方法：200 名 HIV 血清阳性者 参与者（1/2 年龄超过 50 岁）将接受： (1) a 一系列神经心理学测试（都是计算机化的测量 记忆和执行的形成处理和临床测量 函数）由于其假设而被选择 对艾滋病毒感染和正常衰老影响的敏感性 过程; (2)心理功能测量； (3) 措施 已显示的健康信念、意图和相关结构 来预测依从性。 HIV+参与者；对蛋白酶的粘附 然后将对抑制剂进行为期 3 个月的监测。 用药事件 监控系统 (MEMS) 帽，采用微处理器来 自动记录每次服用剂量的日期和时间 遵守索引的“黄金标准”。 鉴于多方确定 依从性的性质以及本研究将涉及的复杂数据集 使用 EQS 进行产量结构方程建模将是主要的 采用的分析策略。 加深对如何进行的理解 神经心理功能障碍影响治疗依从性， 特别是对于老年 HIV + 患者来说，这一点至关重要 不遵守规定对个人和公共健康造成的后果。