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.
AIDS care