PREVALENCE OF HIV ASSOCIATED DEMENTIA AMONG A GROUP OF PEOPLE LIVING WITH HIV

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。随着感染艾滋病毒/艾滋病的人数达到流行病的程度，艾滋病毒/艾滋病的蔓延引起了许多公共卫生关切。因此，对预防感染传播和延长艾滋病病毒感染者寿命的方法进行了越来越多的研究。减少与艾滋病毒/艾滋病有关的死亡率和降低病毒传播的一种确定方法是改善抗逆转录病毒药物的供应和坚持使用（美国卫生与公众服务部，2000年）。然而，为了实现这些目标，严格遵守治疗方案是至关重要的。低于80%的依从性水平与治疗失败、临床恶化、死亡率和病毒突变的风险显著增加有关（Flexner & Piscitelli, 2003）。这些病毒突变导致艾滋病毒对抗逆转录病毒药物产生耐药性（Saag, 2003; Zolopa & D'Aquila, 2003）。耐多药（MDR）菌株正在成为有效管理艾滋病毒的一个主要问题，由于传播和适应性突变，即使在未接受治疗的患者中，耐药菌株的存在也在增加（Levy, 1998; Saag, 2003; Unger, Kreuter & Rubsamen-Waigmann, 2000; Zolopa & D'Aquila, 2003）。虽然很难精确测量，但艾滋病毒感染者的药物依从性水平通常并不高。几项研究发现，依从性通常在20%到80%之间（Flexner & Piscitelli, 2003; Kirton, Talotta & Zwolski, 2001; Nichols et al. 2002）。这种高依从性的一些主要原因是药物副作用，与食物不相容，治疗方案的不便，以及简单地忘记服用药物（Allardice 2002；疾病控制中心，2002;Flexner & Piscitelli, 2003）。然而，健忘的潜在原因尚未得到彻底的临床研究，关于健忘和神经损伤之间的关系的信息也很少。神经系统疾病，特别是那些影响认知功能的疾病，对抗逆转录病毒药物治疗方案的成功构成威胁。注意力难以集中和认知功能障碍相关的记忆障碍使患者难以达到最佳依从性（Kirton, Talotta, & Zwp; slow）。2001年;Nichols et al. 2003)。对艾滋病感染者神经功能障碍的确切发病率估计各不相同，但预计较高，其中痴呆症是最常见的原因（Galicia等人，2000年；Kirton， Talotta和Zwolski， 2001年；Morris 2003年；Nichols等人，2002年）。hiv相关痴呆（HAD）是艾滋病感染者的一种进行性神经系统疾病，具有认知、运动和行为表现。HAD的早期症状包括注意力持续时间缩短，执行任务的能力下降，以及在疾病后期出现的精神运动减慢的记忆丧失（Kirton, Talotta & Zwolski, 2001; Nichols et al. 2002）。行为改变也可能存在，包括冷漠和其他抑郁影响（Kirton, Talotta & Zwolski, 2001）。由于对艾滋病病毒携带者的日常功能的潜在影响，必须在临床环境中更密切地研究HAD，以确定其对药物不依从性问题的贡献。为了检验HAD与抗逆转录病毒药物依从性的关系，我们建议首先通过使用精神状态仪器来测量门诊人群中HAD的发生率。本仪器的使用仅用于研究目的，而不是作为临床诊断工具。只有训练有素的临床医生才能诊断HAD患者。接下来，我们将通过使用两份依从性问卷来确定人群中抗逆转录病毒药物依从性的水平。最后，为了分离HAD症状，我们将使用抑郁量表来排除抑郁是导致不完全服药的一个因素。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The spread of HIV/AIDS has raised many public health concerns as the number of people living with HIV/AIDS (PLWHA) reaches epidemic proportions. Consequently, there has been an increasing amount of research done examining methods of prevention of transmission of infection and increasing the life span of PLWHA. One identified way to reduce the mortality associated with HIV/AIDS and lower the transmission of the virus is to improve the availability of and adherence to antiretroviral medications (U.S. Department of Health and Human Services, 2000). However, in order to fulfill these goals, strict adherence to the treatment program is crucial. Adherence levels of less than eighty percent have been associated with a significant increase in the risk of treatment failures, progressive clinical deterioration, mortality and viral mutations (Flexner & Piscitelli, 2003). These viral mutations lead the HIV to become resistant to antiretroviral medication (Saag, 2003; Zolopa & D'Aquila, 2003). Multidrug resistant (MDR) strains are becoming a major problem in the effective management of HIV and the presence of drug resistant strains are on the rise even in treatment naive patients due to transmission and adaptive mutations (Levy, 1998; Saag, 2003; Unger, Kreuter & Rubsamen-Waigmann, 2000; Zolopa & D'Aquila, 2003). ALthough difficult to measure precisely, medication adherence levels in PLWHA have not typically been high. Several studies have found that adherence generally lies somewhere between twenty to eighty percent (Flexner & Piscitelli, 2003; Kirton, Talotta & Zwolski, 2001; Nichols et al. 2002). Some of the main reasons for this high level of nonadherence are the medication side effects, incompatibilities with food, inconvenience of the regimen, and simply forgetting to take the medications (Allardice 2002; Centers for Disease Control, 2002; Flexner & Piscitelli, 2003). The underlying causes of forgetfulness, however, have not been thoroughly studies clinically and little information exists on the correlation between this forgetfulness and neurological impairment. Neurological disorders, particularly those which affect cognitive function, pose a threat to the success of an antiretroviral medication regimen. The difficulty in concentration and the ensuring memory impairment associated with cognitive dysfunction make it difficult for patients to achieve optimal adherence(Kirton, Talotta, & Zwp;slo. 2001; Nichols et al. 2003). Estimates of the exact incidence of neurological dysfunction among PLWHA vary but are projected to be high, with dementia being the most common cause (Galicia et al. 2000; Kirton, Talotta & Zwolski, 2001; Morris 2003; Nichols et al. 2002). HIV-associated dementia (HAD) is a progressive neurological disorder in PLWHA with cognitive, motor and behavioral manifestations. Early signs of HAD include decreased attention span, decreased ability to perform tasks, and memory loss with psychomotor slowing occurring later in the disease process (Kirton, Talotta & Zwolski, 2001; Nichols et al. 2002). Behavioral changes might also be present and include apathy and other depressive affects (Kirton, Talotta & Zwolski, 2001). Due to the potential effects on the daily functioning of PLWHA, HAD must be studied more closely in the clinical setting to determine its contribution to the problem of nonadherence to medication. In order to examine HAD in relation to antiretroviral medication adherence, we propose to first measure the occurrence of HAD in an outpatient population through the use of a mental status instrument. The use of this instrument is intended solely for research purposes and not as a clinical diagnostic tool. Only a trained clinician can diagnose a patient with HAD. Next, we will determine the level of antiretroviral medication adherence in the population through the use of two adherence questionnaires. Lastly, in an effort to isolate HAD symptomology, we will administer a depression scale to rule out depression as a contributing factor to incomplete medication adherence.