title: Methamphetamine use and neuropsychiatric factors are associated with antiretroviral non-adherence.
abstract: The present study assesses the impact of methamphetamine (METH) on antiretroviral therapy (ART) adherence among HIV+ persons, as well as examines the contribution of neurocognitive impairment and other neuropsychiatric factors [i.e., major depressive disorder (MDD), antisocial personality disorder (ASPD), and attention deficit disorder (ADHD)] for ART non-adherence. We examined HIV+ persons with DSM-IV-diagnosed lifetime history of METH abuse/dependence (HIV+ /METH+ ; n=67) as compared to HIV+ participants with no history of METH abuse/dependence (HIV+ /METH - ; n=50). Ancillary analyses compared these groups with a small group of HIV+ /METH+ persons with current METH abuse/dependence (HIV+ /CU METH+ ; n=8). Non-adherence was defined as self-report of any skipped ART dose in the last four days. Neurocognitive functioning was assessed with a comprehensive battery, covering seven neuropsychological domains. Lifetime METH diagnosis was associated with higher rates of detectable levels of plasma and CSF HIV RNA. When combing groups (i.e., METH+ and METH- participants), univariate analyses indicated co-occurring ADHD, ASPD, and MDD predicted ART non-adherence (p's < 0.10; not lifetime METH status or neurocognitive impairment). A significant multivariable model including these variables indicated that only MDD uniquely predicted ART non-adherence after controlling for the other variables (p<0.05). Ancillary analyses indicated that current METH users (use within 30 days) were significantly less adherent (50% prevalence of non-adherence) than lifetime METH+ users and HIV+ /METH- participants and that neurocognitive impairment was associated with non-adherence (p's < 0.05). METH use disorders are associated with worse HIV disease outcomes and ART medication non-adherence. Interventions often target substance use behaviors alone to enhance antiretroviral treatment outcomes; however, in addition to targeting substance use behaviors, interventions to improve ART adherence may also need to address coexisting neuropsychiatric factors and cognitive impairment to improve ART medication taking.
authors.affiliation: Department of Psychiatry, University of California, San Diego, San Diego, CA, USA. djmoore@ucsd.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Moore
authors.forename: Kaitlin
authors.initials: K
authors.lastname: Blackstone
authors.forename: Steven Paul
authors.initials: SP
authors.lastname: Woods
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: J Hampton
authors.initials: JH
authors.lastname: Atkinson
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heaton
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000150:complications / Q000523:psychology*; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage*; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008694:Methamphetamine / Q000008:administration & dosage*; D008875:Middle Aged; D009483:Neuropsychological Tests; D016903:Drug Monitoring
chemical_list: D000697:Central Nervous System Stimulants; D008694:Methamphetamine