title: Interactive effects of neurocognitive impairment and substance use on antiretroviral non-adherence in HIV disease.
abstract: While numerous studies have established the adverse independent effects of clinical conditions including neurocognitive dysfunction, psychiatric illness, and substance abuse/dependence on medication adherence among HIV-infected adults, fewer have studied their interactive effects. The current study examined this issue among 204 HIV-infected participants based upon current neurocognitive functioning and DSM-IV-diagnosed psychiatric illness and current substance abuse or dependence. Results confirmed that participants with any of these risk factors demonstrated poorer adherence than individuals with no risk factors. A neurocognitive status × substance abuse/dependence interaction was also identified such that participants with impaired neurocognition and a co-occurring substance abuse/dependence diagnosis demonstrated the poorest adherence. Results confirm the deleterious impact of these risk factors in isolation and also identify a specific interactive effect for individuals with comorbid neurocognitive impairment and a substance abuse/dependence disorder. Findings highlight the need for interventions that simultaneously address these problems.
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA Nthaler@mednet.ucla.edu.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Thaler
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Sayegh
authors.affiliation: Department of Neurology, University of Washington, Seattle, WA, USA.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA Department of Psychology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Castellon
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA Department of Psychology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Hinkin
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods* / Q000523:psychology*; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology*; D016903:Drug Monitoring
keywords: Drug and alcohol abuse; HIV/AIDS