HIV+Drug Users: Neurocognitive Aspects of ARV Adherence

描述(由申请人提供)：要有效抑制艾滋病毒复制，需要高度坚持抗逆转录病毒药物。依从性不足会导致耐药性，从而限制了当前感染者和新感染者的治疗选择。虽然物质使用是公认的依从性差的风险因素，但还需要更多的研究来具体了解物质使用者的不遵守情况。与艾滋病毒感染和药物使用相关的认知障碍可能会阻碍坚持抗逆转录病毒治疗(ART)。我们对HIV+物质使用者的横断面研究表明，精神运动减慢与不坚持有关。目前关于ART依从性的认知预测因素的研究受到研究周期较短的限制。然而，在找到治愈方法之前，坚持艺术是终生的承诺。因此，有必要开始揭示在最脆弱的人群中，随着时间的推移，遵守的动态和影响它的因素。本研究的目的是评估基线神经认知技能结合其他与依从性相关的因素(包括活性物质使用、自我效能、抑郁症状和健康素养)在物质依赖的样本(主要是非裔美国人和西班牙裔)、HIV+男性和女性(N=200)中预测依从性的能力。参与者将对艺术很天真，并将开始他们的第一个艺术养生法。在抗逆转录病毒治疗开始之前，所有参与者都将接受药物耐药性测试(通过基因耐药性分析)。我们将每隔4周测量一次依从性(使用MEMS、药片计数和自我报告)，为期6个月。我们还将评估认知状态的变化是否与坚持6个月以上的措施有关。鉴于使用艾滋病毒+的男性和女性主要是少数族裔，他们遭受的艾滋病相关发病率和死亡率比他们的白人同行更高，因此需要了解和解决这一群体中治疗依从性差的原因。这项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。由于对抗逆转录病毒疗法的高度依从性大大减少了艾滋病毒药物耐药性的发展，因此，改善目前感染者的依从性将有利于公众健康，因为它可以保持对未来艾滋病毒/艾滋病病例的可用治疗。

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.