The influence of neurocognitive impairment on HIV treatment outcomes among drug-involved people living with HIV/AIDS

Abstract

Findings to date indicate that it is feasible to deliver a brief behavioral risk reduction/medication adherence group intervention to HIV-infected IDUs in a community-based setting. HIV infection and substance abuse can result in neurocognitive impairment and this is directly relevant to intervention development because a significant number of people living with HIV/AIDS have a positive history of substance abuse and being able to successfully participate in behavioral interventions often requires a relatively high level of cognitive performance. The aim of the current study was to evaluate if changes in information, motivation and behavior skills with respect to medication adherence, sex- and drug-risk behavior outcomes from baseline to post-intervention is predicted by cognitive impairment following the brief 4-session Holistic Health for HIV intervention for HIV-infected Drug Users (3H+). Significant associations were found between change in motivation and certain neurocognitive performance domains. Findings suggest that it may be helpful to specifically tailor such behavioral interventions to accommodate cognitive impairment.

Alcohol use disorders negatively influence antiretroviral medication adherence among men who have sex with men in Peru

“…The high GMI scores in our sample [50.8 (±10.8) of 80 maximum] suggest most participants had some degree of NCI. This is concerning because individuals with mild to moderate NCI may experience sub-optimal ART adherence [44] and increased HIV risk behaviors [70]. In turn, NCI symptoms will worsen in HIV-infected people not taking ART [71], because ART reverses some, but not all NCI-related symptoms [72].…”

“…In turn, NCI symptoms will worsen in HIV-infected people not taking ART [71], because ART reverses some, but not all NCI-related symptoms [72]. Although the general measure of NCI did not remain significant in the multivariate model, it is possible that only the most severely neurocognitively impaired (e.g., worst decile) [43] or those with impairment of only one or a few of the cognitive domains (e.g., memory, learning ability, attention) [44] show suboptimal ART adherence [73]. Further exploration of NCI severity and NCI subscales on ART adherence is warranted.…”

“…Though the NIS features many subscales, we focused only on the influence of general cognitive impairment, which was analyzed using a validated NCI summary score called the Global Measure of Impairment (GMI). Consistent with prior analyses involving the NIS, raw scores were transformed to t-scores and then treated as a continuous variable [44]. Facilitators of ART adherence included a battery of cues and reminders often used to assist medication-taking, like alarm clocks and calendars, association with meals and hour of sleep, reminders from friends, and putting ART in a highly visible place.…”

Modeling a theory-based approach to examine the influence of neurocognitive impairment on HIV risk reduction behaviors among drug users in treatment

“…Although the number of diagnosed HIV infections attributed to people who use drugs (PWUDs) has decreased in recent years (1), they still remain a priority population for the prevention of HIV because they represent a critical conduit for new HIV infections, and because this occurs through preventable drug-related (e.g., needle sharing) and sex-related (e.g., inconsistent condom use) HIV risk behaviors (2)(3)(4)(5)(6). As a result of chronic drug use, related lifestyle experiences, and relatively poor health (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), a disproportionate percentage of PWUDs experience neurocognitive impairment (NCI) to the extent that it may interfere with their ability to fully participate in treatment (18)(19)(20). It is well documented that HIV-infected PWUDs may experience cognitive impairment associated with the disease process (AIDS-related dementia) (14-17, 19, 21-27), but HIV-PWUDs also demonstrate levels of NCI that may be disruptive to their participation in treatment services (18,(28)(29)(30)(31).…”

“…An application of health behavior change theory to HIV prevention among PWUDs can help researchers to identify the critical dynamics of this particular population HIV risk behaviors in need of targeted intervention efforts, and to empirically evaluate the ability of these theories to predict and promote prevention behavior. The theoretical approach used for this analysis is the Information-Motivation-Behavioral Skills model of health behavior change (IMB) (34,35) -a theoretical model, which has been successfully applied to the design and evaluation of a wide range of intervention approaches targeting various patient populations and diseases (14,(36)(37)(38)(39)(40)(41).…”