COGNITIVE DEFICITS AND MEDICATION ADHERENCE IN HIV/AIDS

说明(申请人摘要)：介绍蛋白酶 抑制剂在患者和提供者中带来了相当大的乐观情绪 相似的，但已经表明，除非患者严格遵守 他们的用药方案，会增加病毒的复制和蛋白水解酶 将会出现抗药性的病毒突变。因此，它是 最重要的是查明不遵守的原因，并 被根除了。不遵守的一个潜在原因，特别是在老年人 HIV+患者，这一问题尚未得到充分解决， 神经心理障碍。这项研究的主要目的是 确定神经心理损伤的影响，特别是 记忆缺陷(前瞻性、回溯性和工作性)，双重 HIV阳性患者的任务/执行功能障碍和抑郁/冷漠； 坚持他们的蛋白水解酶抑制疗法。一个必然的目标是 确定老年是如何增强艾滋病毒的有害影响的- 与坚持相关的认知能力下降。第二个目标是 确定增龄和增龄的独立和交互影响 HIV感染对神经认知和神经精神功能的影响。这个 这项研究的中心假设是与艾滋病毒相关的认知 损害将导致较差的治疗依从性以及这种关系 会在年龄较大的患者身上放大。方法：200例HIV血清阳性者 参与者(50岁以上的一半)将接受以下管理：(1)a 一系列神经心理测试(都是计算机化的测量 记忆和执行的形成过程及临床测量方法 函数)，它们之所以被选择是因为它们的假设 对HIV感染和正常衰老影响的敏感性 过程；(2)心理功能测量；(3)心理功能测量 已显示的健康信念、意图和相关概念 以预测其遵守情况。HIV+的参与者；对蛋白酶的坚持 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)CAPS，采用微处理器 自动记录每次服药的日期和时间将是 坚持索引的“黄金标准”。给出多个确定的 坚持的性质以及这项研究将设置的复杂数据集 使用EQS的产量结构方程建模将是主要的 采用了分析策略。加深了对如何 神经心理障碍对治疗依从性的影响 特别是在老年HIV+患者中，具有至关重要的意义 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.