title: Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse.
abstract: OBJECTIVE
  To examine the predictors of antiretroviral adherence among HIV-infected adults, with a particular focus on advancing age, neuropsychological dysfunction, and substance abuse.
  
  
  METHODS
  : Prospective observational design.
  
  
  METHODS
  Participants were 148 HIV-infected adults between the ages of 25 and 69 years, all on a self-administered antiretroviral regimen. Medication adherence was tracked over a one-month period using an electronic monitoring device (medication event monitoring system caps). All participants completed a comprehensive battery of neuropsychological tests as well as a structured psychiatric interview.
  
  
  RESULTS
  The mean adherence rate for the entire cohort was 80.7%, with older patients (> or = 50 years) demonstrating significantly better medication adherence than younger patients (87.5 versus 78.3%). Logistic regression analyses found that older patients were three times more likely to be classified as good adherers (defined as > or = 95% adherent). Neurocognitive impairment conferred a 2.5 times greater risk of poor adherence. Among the older patients, those who were classified as poor adherers performed significantly worse on neuropsychological testing, particularly on measures of executive function and psychomotor speed. Current drug abuse/dependence, but not current alcohol abuse/dependence, was also associated with sub-optimal medication adherence.
  
  
  CONCLUSIONS
  Although older age is associated with higher rates of antiretroviral adherence, older participants who were cognitively impaired showed disproportionate difficulty in adequately adhering to their medication regimen. As such, efforts to detect neuropsychological dysfunction, particularly among older patients, and a thorough assessment of substance abuse, appear to be essential for the effective treatment of HIV-infected adults.
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles,and Psychology Service, VA Greater Los Angeles Health Care System, 90024, USA. chinkin@ucla.edu
authors.forename: Charles H
authors.initials: CH
authors.lastname: Hinkin
authors.forename: David J
authors.initials: DJ
authors.lastname: Hardy
authors.forename: Karen I
authors.initials: KI
authors.lastname: Mason
authors.forename: Steven A
authors.initials: SA
authors.lastname: Castellon
authors.forename: Ramani S
authors.initials: RS
authors.lastname: Durvasula
authors.forename: Mona N
authors.initials: MN
authors.lastname: Lam
authors.forename: Marta
authors.initials: M
authors.lastname: Stefaniak
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D003042:Cocaine / Q000009:adverse effects; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology*; D016903:Drug Monitoring; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D010349:Patient Compliance / Q000523:psychology*; D011446:Prospective Studies; D011597:Psychomotor Performance; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology*
chemical_list: D003042:Cocaine