Simpler therapies may help improve outcomes for HIV patients

December 23, 2002

ST. PAUL, MN - HIV-infected patients with cognitive impairment are more likely to fail to take their medications than those without cognitive impairment, according to a study published in the December 24 issue of Neurology, the scientific journal of the American Academy of Neurology. Failure to take prescribed medications can cause the disease to progress and can even lead to the development of drug-resistant HIV strains.

Those patients with cognitive impairment who were required to take medications three times per day were more likely to fail to adhere to the medication schedule than those who were given a schedule of once or twice per day. HIV-related cognitive impairment can include mild to severe memory problems, difficulties with planning and judgement, and reductions in how fast the brain can process information. The research doesn't prove that cognitive impairment causes people to lapse in their medication schedules, according to study author Charles Hinkin, PhD, of the David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Health Care System.

"In fact, it could be the opposite -- poor adherence to one's medication schedule may have many damaging consequences, including cognitive decline," Hinkin said.

Hinkin suggests that HIV patients with cognitive decline be given simpler dosing schedules for their medications to try to improve the likelihood that they will take all of their doses. The study involved 137 adults with HIV in the Los Angeles area. All of the patients were taking highly active antiretroviral therapy (HAART). Neuropsychological tests determined that 34 percent of the patients were cognitively impaired.

Pill bottles with computer chips embedded in the caps were used to monitor how well patients followed the medication schedule over four weeks. The chips automatically recorded the date, time and duration of any opening of the pill bottle.

Proper adherence to the medication schedule was defined as taking 95 percent of prescribed medications. On average, those with cognitive impairment followed the schedule 70 percent of the time; cognitively normal patients adhered 82 percent of the time. For patients with cognitive impairment, those who took medications three times a day followed the schedule 52 percent of the time, compared to 78 percent for those who took medications once or twice a day. For people with no cognitive impairment, those who took medications three times a day adhered 79 percent of the time, compared to 84 percent of the time for those who took their medications once or twice a day.

The study also found that patients who were over 50 years old were nearly three times as likely to adhere to their medication schedules than people under 50, regardless of their cognitive status.

Hinkin and his colleagues are doing further research on what factors can help predict which patients will have trouble following their medication schedules. "While it appears clear that cognitive impairment is associated with poor medication adherence, other factors such as drug and alcohol abuse, psychiatric illness, and lack of ready access to health care are also important risk factors," said Hinkin.

"People who don't follow the medication schedules are at higher risk for disease progression, opportunistic infections and even developing drug-resistant strains of the virus," he said. "The better we can understand how to help patients stick to their medication schedules, the more we can reduce these adverse outcomes."
-end-
The study was supported by a grant from the National Institute of Mental Health, with supplemental funds provided by the National Institute on Drug Abuse.

The American Academy of Neurology, an association of more than 18,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. For more information about the American Academy of Neurology, visit its web site at www.aan.com.

For more information contact: Kathy Stone, 651-695-2763, kstone@aan.com
For a copy of the study contact: Cheryl Alementi at 651-695-2737, calementi@aan.com

American Academy of Neurology

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