Reciprocal prediction of medication adherence and neurocognition in HIV/AIDS.
BACKGROUND
Antiretroviral medications have been shown to benefit neurocognition in HIV/AIDS, and neurocognitive deficits are a risk factor for poor adherence to these medications. However, little is known about the predictive pathways linking medication adherence with cognitive ability.


METHODS
In the current 6-month cohort study, antiretroviral medication adherence was tracked prospectively among 91 HIV-positive adults using electronic monitoring. Comprehensive neuropsychological evaluations were performed at baseline and 6 months.


RESULTS
Multivariate path analyses provided evidence that antiretroviral adherence and cognitive ability are reciprocally related, although the neurocognitive pathways of this relationship appear to vary by predictive direction. Executive function and learning/memory were most strongly predictive of levels of medication adherence achieved, whereas higher levels of adherence were predictive of relative improvements in a wide range of frontostriatal brain functions including processing speed, attention, executive functions, and motor functioning.


CONCLUSIONS
These data provide evidence that cognition and adherence are reciprocally related in HIV/AIDS. In particular, executive dysfunction may play a key role in this relationship. Interventions aimed at improving or preserving executive functions could hold promise for interrupting progressive declines in adherence and neurocognitive ability in HIV/AIDS.
Ettenhofer
Mark L
ML
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, CA, USA. mark.ettenhofer@usuhs.mil
Foley
Jessica
J
Castellon
Steven A
SA
Hinkin
Charles H
CH
D000163:Acquired Immunodeficiency Syndrome / Q000523:psychology*; D000328:Adult; D001288:Attention / Q000502:physiology; D003071:Cognition / Q000502:physiology*; D015331:Cohort Studies; D056344:Executive Function / Q000502:physiology; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D007858:Learning / Q000502:physiology; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires