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. 2017 Apr 6;4(2):ofx070.
doi: 10.1093/ofid/ofx070. eCollection 2017 Spring.

The Presence of Human Immunodeficiency Virus-Associated Neurocognitive Disorders Is Associated With a Lower Adherence to Combined Antiretroviral Treatment

Susan Kamal  1   2 , Isabella Locatelli  1   3 , Gilles Wandeler  4   5 , Asemaneh Sehhat  1   2 , Olivier Bugnon  1   2 , Melanie Metral  6 , Renaud Du Pasquier  6 , Klemens Gutbrod  7 , Matthias Cavassini  8 , Marie P Schneider  1   2 ; and the Swiss HIV Cohort Study
Affiliations

The Presence of Human Immunodeficiency Virus-Associated Neurocognitive Disorders Is Associated With a Lower Adherence to Combined Antiretroviral Treatment

Susan Kamal et al. Open Forum Infect Dis. .

Abstract

Background: Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) are defined according to their diagnostic degrees as follows: asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia. Because high adherence to combined antiretroviral therapy (cART) is required to maintain viral suppression among HIV-infected patients, it is important to investigate the impact of HAND on medication adherence. Our study hypothesis was that patients with HAND had a lower medication adherence than patients who did not have HAND.

Methods: This was an observational, exploratory, 2-center pilot study of patients who had a state-of-the-art neurocognitive assessment performed between January 2011 and June 2015 while also being followed at their respective adherence clinics. Adherence was measured with electronic monitors. Patients' sociodemographic characteristics, HIV viral load, and CD4 counts were retrieved from the Swiss HIV Cohort Study database. At each time t, adherence was computed as the proportion of patients taking medication as prescribed at that time.

Results: We included 59 patients, with a median (Q1, Q3) age of 53 years (47-58) and 39 (66%) were male participants. Twenty-two patients (35%) had no neurocognitive deficits, 16 (27%) patients had HAND, and 21 (35%) patients had non-HAND (mostly depression). Implementation over 3 years showed a significant decline (50%) in medication adherence among patients diagnosed with HAND in comparison with patients who had a normal neuropsychological status or a non-HIV-related cognitive deficit (implementation stayed 90% during follow-up).

Conclusions: Our findings support the hypothesis that HAND is associated with reduced cART adherence.

Keywords: HIV; HIV-associated neurocognitive disorders; medication adherence..

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Figures

Figure 1.
Figure 1.
Adherence to cART per neurocognitive group over time. Abbreviation: HIV, human immunodeficiency virus.
Figure 2.
Figure 2.
Human immunodeficiency virus (HIV) ribonucleic acid (RNA) detectability over time per neurocognitive group.
See this image and copyright information in PMC

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