HIV+ Drug Users: Neurocognitive Aspects of ARV Adherence

描述（由申请人提供）：为了有效抑制HIV病毒复制，需要高度坚持抗逆转录病毒药物治疗。依从性不足导致耐药性，这限制了当前和新感染者的治疗选择。虽然药物使用是公认的不良依从性的危险因素，但需要更多的研究来具体了解药物使用者的不依从性。与艾滋病毒感染和药物使用相关的认知障碍可能阻碍抗逆转录病毒治疗（ART）的坚持。我们对HIV阳性药物使用者的横断面研究表明，精神运动减缓与不依从性有关。目前对抗逆转录病毒治疗依从性的认知预测因素的研究受限于研究时间短。然而，在找到治疗方法之前，坚持抗逆转录病毒治疗是一项终身承诺。因此，有必要开始揭示最脆弱人群坚持服药的动态以及长期影响这种情况的因素。本研究的目的是评估基线神经认知技能的能力，以预测6个月以上的依从性，并结合其他与依从性相关的因素，包括积极的药物使用、自我效能、抑郁症状和健康素养，主要是药物依赖样本，非裔美国人和西班牙裔，HIV阳性男性和女性（N = 200）。参与者将是ART的新手，并将开始他们的第一个ART方案。在开始抗逆转录病毒治疗之前，将对所有参与者进行耐药性检测（通过基因型耐药测定）。我们将测量依从性（使用MEMs，药片计数和自我报告），每4周间隔6个月。我们还将评估认知状态的改变是否与6个月以上的依从性测量有关。鉴于使用艾滋病毒阳性药物的男性和女性主要是少数民族，他们比白人遭受更高的艾滋病相关发病率和死亡率，因此有必要了解和解决导致该群体治疗依从性差的因素。本研究的结果将转化为基于经验的预防和早期干预策略，以提高这一高危群体的依从性。由于高度坚持抗逆转录病毒药物治疗大大减少了艾滋病毒耐药性的发展，因此，目前感染者坚持治疗将有利于公共卫生，因为对未来的艾滋病毒/艾滋病病例保持可用的治疗。

DESCRIPTION (provided by applicant): High levels of adherence to antiretroviral medications are required for effective suppression of HIV viral replication. Inadequate adherence leads to drug resistance, which limits treatment options for both the currently and newly infected. Although substance use is a recognized risk factor for poor adherence, more study is needed to understand non-adherence in substance users specifically. Cognitive impairment associated with HIV infection and substance use may impede adherence to antiretroviral therapy (ART). Our cross-sectional research with HIV+ substance users showed that psychomotor slowing was related to non- adherence. Current research on cognitive predictors of adherence to ART is limited by short study periods. Yet until a cure is found, adherence to ART is a lifelong commitment. It is therefore necessary to begin to unravel the dynamics of adherence and the factors that influence it over time in the most vulnerable populations. The purpose of this study is to assess the ability of baseline neurocognitive skills to predict measures of adherence over 6 months in combination with other factors related to adherence including active substance use, self-efficacy, symptoms of depression, and health literacy in a sample of substance dependent, mostly African American and Hispanic, HIV+ men and women (N = 200). Participants will be naive to ART and will be starting their first ART regimen. All participants will be tested for medication resistance (via genotypic resistance assays) prior to start of ART. We will measure adherence (using MEMs, pill count & self-report) at 4-week intervals for 6 months. We will also assess if change in cognitive status is related to measures of adherence over 6 months. Given that substance using HIV+ men and women are primarily ethnic minorities who suffer greater AIDS related morbidity and mortality than their white counterparts, the need to understand and address contributors to poor treatment adherence in this group is essential. Findings from this study will be translated into empirically-based prevention and early intervention strategies to improve adherence in this high risk group. Since high adherence to ART greatly diminishes the development of HIV medication resistance, improved adherence in the currently infected will benefit public health by maintaining available treatments for future cases of HIV/AIDS.