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Adherence to antiretroviral therapy and neurocognitive impairment in South Africa / 55% neurocognitively impaired / 64% nonadherent
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from Jules: this study was conducted in HIV+ Black south African adults, age 33. 55% were characterized ... as neuropsychologically impaired. and adherence for the first 6-months post-ART initiation was 64%..... Non-adherence & neurocognitive impairment are associated in this study, although the authors say "Six-month adherence, age, and education were significant predictors of GDS, such that worse GDS was predicted by worse adherence" - perhaps neurocognitive impairment contributes to non-adherence as well, - which is very relevant to aging & HIV - older aging HIV+ with neurologic & cognitive impairments will have adherence challenges ! AS WELL, non-adherence leading to detectable viral load & sub-optimal CD4 response in these young adults, only 33, will increase risks for inflammation, immune activation, accelerated aging & increased comorbidities.
Reported by Jules Levin
Durban 2016 July 18-22
Presenter
Reuben Robbins
Authors
R. Robbins1, H. Gouse2, C. Mellins1, M. Arce Renteria3, K. Thomas4, V. Jonah2, R. Remien1, J. Joska2
Institutions
1Columbia University and New York State Psychiatric Institite, Psychiatry, New York, United States, 2University of Cape Town, Psychiatry and Mental Health, Cape Town, South Africa, 3Fordham University, Psychology, Bronx, United States, 4University of Cape Town, Psychology, Cape Town, South Africa
Background: Despite improvement in antiretroviral treatment (ART), neurocognitive impairment remains prevalent among people living with HIV (PLWH). It is generally thought that neuroinflammation, rather than high viral load, may be responsible for neurocognitive impairment in HIV, and that early ART minimizes neuroinflammation. For ART to be optimally effective high adherence (>90%) is required. Non-adherence may result in neurocognitive impairment, as well as poor health outcomes, decreased activities of daily living. This study examined the relationship between ART adherence and neuropsychological functioning among HIV+ South Africans for their first 6-months on ART.
Methods: One-hundred and two, isiXhosa-speaking, HIV+ Black South African adults initiating ART and who were enrolled in an ongoing ART adherence intervention trial monitoring ART adherence were administered a comprehensive neuropsychological test battery 12 months post-ART initiation. Locally normed Z-scores were computed for all tests in the battery and were used to calculate a global deficit score (GDS) where 0.5 or higher indicated at least mild impairment. Adherence was continuously measured using an electronic monitoring device (WisePill). One-year post-ART initiation viral load test results were abstracted from medical charts. Multiple linear regression examined the relationship between adherence and GDS.
Results: Participants were 33 years old (SD=7.5 years), and 81% female; most (80%) had not graduated from high school. Using the cut-score, 55% of the sample were classified as neuropsychologically impaired. Mean adherence for the first 6-months post-ART initiation was 64% (SD=31%). Of the 73 viral load test results available from medical charts, only 3% (n=2) had detectable virus. A multiple linear regression was calculated to predict GDS based on first 6-months adherence, gender, age, and education. A significant regression equation was found (F(4,97)=8.52, p< .000) with an R2 of .26. Six-month adherence, age, and education were significant predictors of GDS, such that worse GDS was predicted by worse adherence (B=-.27, p=.003), older age (B=.21, p=.045), and lower education (B=-.36, p=.000).
Conclusions: These findings provide some preliminary evidence that early non-adherence may be related to worse neuropsychological functioning at one-year post-ART initiation in mostly virally suppressed HIV+ South Africans. Future research needs to examine this relationship in a larger sample.
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