Predictors: Medication Adherence in HIV+ Cocaine Abusers

艾滋病毒感染的可卡因滥用者服药依从性和抗逆转录病毒耐药性的预测尽管高效抗逆转录病毒疗法(HAART)已被证明可显著降低艾滋病毒感染者的发病率和死亡率，但如果没有严格的用药依从性，病毒复制将随之而来，抗逆转录病毒耐药性艾滋病毒将出现变异。在HIV+患者中，越来越多的证据表明，那些特别可能表现出较差依从性的人是那些表现出严重神经心理损害的人和那些滥用/依赖可卡因的人。使用结构方程建模方法，拟议的研究将调查在HIV+可卡因滥用患者的多种族样本中，可卡因滥用、神经认知功能障碍、精神障碍、心理社会因素、人口统计特征和药物方案复杂性对药物依从性的影响。依从性将通过使用计算机化的药物事件监测系统(MEMS)上限、药片计数、依从性问卷和自我报告来客观确定。具体目标包括：(1)可卡因滥用/依赖如何影响艾滋病毒感染者的服药依从性，以及这种影响如何与时间和其他感兴趣的变量相互作用；(2)可卡因滥用和坚持失败的模式是否与抗逆转录病毒耐药艾滋病毒变异的发展有关，如通过基因耐药分析确定的指数；(3)用药依从性与神经认知、精神状态、冒险行为、医疗决策和其他关键的社会心理和社会文化因素等因素之间的预测关系；(4)制订将可靠地确定粘附者/非吸毒者亚型的风险因素和保护因素的分类。这些问题将由我们的多学科团队在300名艾滋病毒+可卡因滥用/依赖成年人的不同样本中进行调查。将在基线上实施一系列全面的心理社会措施和神经心理测试，并将使用MEMS CAPS方法每月监测受试者对其处方医疗方案的遵守情况，为期6个月。还将在基线和研究完成时采集血样，并进行分析，以确定是否出现抗逆转录病毒耐药艾滋病毒突变。预计这项研究的结果将有助于确定那些被诊断为HIV+的双重诊断患者特别可能是未坚持治疗的患者，并为干预措施提供目标，以提高这一高危人群的治疗依从性。

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 include: (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.