Predictors: Medication Adherence in HIV+ Cocaine Abusers

HIV感染者服药依从性和抗逆转录病毒耐药性的预测因素尽管高效抗逆转录病毒疗法（HAART）已显示出显著降低HIV感染者的发病率和死亡率，但如果没有严格的服药依从性，病毒复制将随之发生，抗逆转录病毒耐药性HIV突变将出现。 在艾滋病毒阳性患者中，越来越多的证据表明，那些特别可能表现出不良依从性的人是那些明显的神经心理障碍和可卡因滥用/依赖的人。 使用结构方程建模方法，拟议的研究将调查可卡因滥用，神经认知功能障碍，精神障碍，社会心理因素，人口统计学特征和药物治疗方案的复杂性对药物依从性的影响，在多种族样本的HIV+可卡因滥用患者。 将通过使用计算机化药物事件监测系统（MEMS）帽、药丸计数、依从性问卷和自我报告客观确定依从性。 具体目标包括：（1）可卡因滥用/依赖如何影响HIV+个体的药物依从性，以及这如何与时间和其他感兴趣的变量相互作用;（2）可卡因滥用和依从性失败的模式是否与抗逆转录病毒抗性HIV突变的发展相关，如通过基因型抗性测定所指示的;（3）药物治疗依从性与神经认知、精神状态、冒险行为、医疗决策以及其他关键的社会心理和社会文化因素之间的预测关系;和（4）发展一种危险因素和保护因素的分类法，以可靠地识别粘附者/非粘附者的亚型。 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。 将在基线时进行一系列全面的心理社会测量和神经心理学测试，并采用MEMS caps方法每月监测受试者对其处方药物治疗方案的依从性，持续6个月。 还将在基线和研究完成时采集血液样本，并进行分析以确定是否出现抗逆转录病毒耐药HIV突变。 预计本研究的结果将有助于识别那些特别可能不依从的双重诊断HIV+患者，并为干预措施的目标提供信息，以提高这一高风险人群的治疗依从性。

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.