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

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。随着艾滋病毒/艾滋病携带者人数达到流行比例，艾滋病毒/艾滋病的蔓延引起了许多公共卫生问题。因此，对预防感染传播和延长PLWHA寿命的方法进行了越来越多的研究。减少与艾滋病毒/艾滋病相关的死亡率和减少病毒传播的一种已确定的方法是改善抗逆转录病毒药物的供应和坚持(美国卫生与公众服务部，2000)。然而，为了实现这些目标，严格遵守治疗计划是至关重要的。依从性水平低于80%与治疗失败、临床逐渐恶化、死亡率和病毒变异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抗药性(Saag，2003；Zolopa&D‘Aquila，2003)。多药耐药(MDR)菌株正在成为有效管理艾滋病毒的一个主要问题，即使在接受治疗的未接受治疗的患者中，由于传播和适应性突变，耐药菌株的出现也在上升(Levy，1998；Saag，2003；Unger，Kreuter&Rubsamen-Waigmann，2000；Zolopa&D‘Aquila，2003)。虽然很难准确衡量，但PLWHA的服药依从性水平通常并不高。一些研究发现，依从性一般在20%到80%之间(Flexner&Piscitelli，2003；Kirton，Talotta&Zwolski，2001；Nichols等人)。2002年)。这种高度不依从性的一些主要原因是药物副作用、与食物的不相容、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，健忘的潜在原因还没有在临床上得到彻底的研究，关于这种健忘和神经损害之间的相关性的信息也很少。神经疾病，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。与认知功能障碍相关的注意力困难和确保记忆障碍使患者很难达到最佳的依从性(Kirton，Talotta，&ZWP；slo)。2001年；Nichols等人。2003年)。对PLWHA中神经功能障碍确切发生率的估计各不相同，但预计会很高，痴呆症是最常见的原因(Galicia等人)。2000年；Kirton，Talotta&Zwolski，2001；Morris 2003；Nichols等人。2002年)。HIV相关性痴呆(HAD)是PLWHA中的一种进行性神经疾病，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减少，执行任务的能力降低，以及记忆丧失，精神运动减慢发生在疾病过程的后期(Kirton，Talotta&Zwolski，2001；Nichols等人)。2002年)。行为变化也可能存在，包括冷漠和其他抑郁影响(Kirton，Talotta&Zwolski，2001)。由于对PLWHA日常功能的潜在影响，HAD必须在临床环境中进行更密切的研究，以确定其对不坚持用药问题的贡献。为了检查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工具来测量门诊人群中HAD的发生情况。该仪器的使用仅用于研究目的，而不是临床诊断工具。只有训练有素的临床医生才能诊断出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，我们将实施抑郁评定量表，以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.