Kamal Susan, Locatelli Isabella, Wandeler Gilles, Sehhat Asemaneh, Bugnon Olivier, Metral Melanie, Du Pasquier Renaud, Gutbrod Klemens, Cavassini Matthias, Schneider Marie P
Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.
Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland.
Open Forum Infect Dis. 2017 Apr 6;4(2):ofx070. doi: 10.1093/ofid/ofx070. eCollection 2017 Spring.
Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) are defined according to their diagnostic degrees as follows: asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia. Because high adherence to combined antiretroviral therapy (cART) is required to maintain viral suppression among HIV-infected patients, it is important to investigate the impact of HAND on medication adherence. Our study hypothesis was that patients with HAND had a lower medication adherence than patients who did not have HAND.
This was an observational, exploratory, 2-center pilot study of patients who had a state-of-the-art neurocognitive assessment performed between January 2011 and June 2015 while also being followed at their respective adherence clinics. Adherence was measured with electronic monitors. Patients' sociodemographic characteristics, HIV viral load, and CD4 counts were retrieved from the Swiss HIV Cohort Study database. At each time , adherence was computed as the proportion of patients taking medication as prescribed at that time.
We included 59 patients, with a median (Q1, Q3) age of 53 years (47-58) and 39 (66%) were male participants. Twenty-two patients (35%) had no neurocognitive deficits, 16 (27%) patients had HAND, and 21 (35%) patients had non-HAND (mostly depression). Implementation over 3 years showed a significant decline (50%) in medication adherence among patients diagnosed with HAND in comparison with patients who had a normal neuropsychological status or a non-HIV-related cognitive deficit (implementation stayed 90% during follow-up).
Our findings support the hypothesis that HAND is associated with reduced cART adherence.
人类免疫缺陷病毒（HIV）相关神经认知障碍（HAND）根据诊断程度定义如下：无症状神经认知损害、轻度神经认知障碍和HIV相关痴呆。由于HIV感染患者需要高度坚持联合抗逆转录病毒治疗（cART）以维持病毒抑制，因此研究HAND对药物依从性的影响很重要。我们的研究假设是，患有HAND的患者比未患有HAND的患者药物依从性更低。
这是一项观察性、探索性、双中心的试点研究，研究对象为在2011年1月至2015年6月期间接受了先进神经认知评估，同时在各自的依从性诊所接受随访的患者。使用电子监测器测量依从性。从瑞士HIV队列研究数据库中获取患者的社会人口统计学特征、HIV病毒载量和CD4细胞计数。每次，依从性计算为当时按规定服药的患者比例。
我们纳入了59名患者，年龄中位数（Q1，Q3）为53岁（47 - 58岁），男性参与者39名（66%）。22名患者（35%）无神经认知缺陷，16名患者（27%）患有HAND，21名患者（35%）患有非HAND（主要是抑郁症）。三年的研究显示，与神经心理状态正常或有非HIV相关认知缺陷的患者相比，被诊断为HAND的患者的药物依从性显著下降（50%）（随访期间非HAND患者的依从性维持在90%）。
我们的研究结果支持HAND与cART依从性降低相关的假设。
