HIV-infected individuals with co-occurring bipolar disorder evidence poor antiretroviral and psychiatric medication adherence

Abstract

The contribution of bipolar disorder (BD), a prevalent serious mental illness characterized by impulsivity and mood instability, to antiretroviral (ART) and psychiatric medication adherence among HIV-infected (HIV+) individuals is unknown. We examined medication adherence among 44 HIV+/BD+ persons as compared to 33 demographically- and medically-comparable HIV+/BD- persons. Classification of adherent (≥ 90%) or non-adherent (<90%) based on proportion of correctly taken doses over 30 days was determined using electronic medication monitoring devices. HIV+/BD+ persons were significantly less likely to be ART adherent (47.7%) as compared to HIV+/BD- (90.9%) persons. Within the HIV+/BD+ group, mean psychiatric medication adherence was significantly worse than ART medication adherence, although there was a significant correlation between ART and psychiatric adherence levels. Importantly, 30-day ART adherence was associated with plasma virologic response among HIV+/BD+ individuals. Given the high overlap of HIV and BD, and the observed medication adherence difficulties for these persons, specialized adherence improvement interventions are needed.

Figure 1

HIV+/BD+ participants evidence worse 30-day MEMS antiretroviral adherence rates as compared to HIV+/BD− participants. Note: Thick bar represents Median; error bars include 95% of the distribution; significance determined via Wilcoxon Rank Sum Test.

Figure 2

30-day MEMS psychotropic adherence rates for HIV+/BD+ participants are lower, but not significantly worse as compared to HIV+/BD− participants. Note: Thick bar represents Median; error bars include 95% of the distribution; significance determined via Wilcoxon Rank Sum Test.