| Publication Abstract Display | | Type: Poster | | Title: The effect of apathy on medication adherence in HIV+ persons with a history of Methamphetamine Dependence. | | Authors: Kamat R, Marcotte T, Deutsch R, Umlauf A, Woods SP, Heaton RK, Atkinson JH, Ellis RJ, Grant I, and the HNRP Group | | Date: 02-15-2012 | | Abstract:Objective
Cognitive impairment, substance use history, and psychiatric status are risk factors for poor adherence in HIV+ individuals. Frontostriatal pathology is common to HIV infection (HIV+) and methamphetamine (MA) use, and is also found in individuals exhibiting clinically significant apathy (decreased goal directed behavior; motoric, emotional and cognitive avolition). We hypothesized that, within an HIV+ group with a history of MA dependence, apathy would predict adherence to anti-retroviral medications, even when controlling for depression, duration of drug abstinence, and neuropsychological (NP) status.
Methods
44 HIV+ individuals, currently on antiretroviral (ARV) regimens, and meeting DSM-IV criteria for MA dependence during their lifetime were administered an NP battery, a structured psychiatric interview, and the Frontal Systems Behavioral Scale (clinically significant apathy = T-score > 65). Self-reported non-adherence (i.e., any skipped ARV dose in the last four days) was established using the AIDS Clinical Trials Group Adherence Questionnaire.
Results
16/44 participants reported being non-adherent. A significant multivariate model was found when examining an a priori model of apathy status, last use of MA, global NP impairment, and MDD diagnosis as predictors of self-reported adherence (χ2=19.07, p=.01). Higher levels of apathy (Wald statistic=4.03, p=.045) and recency of MA use (Wald statistic=4.93, p=.026) were independent, statistically significant predictors of worse adherence.
Conclusion
Apathy appears to be significantly associated with HIV medication adherence in individuals with a history of MA dependence. These findings suggest that neuropsychiatric status (particularly apathy) may be a potentially useful target for interventions aimed at improving medication adherence in substance using populations. |
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