Adherence and neurocognitive screening in Romanian HIV patients

Abstract

BackgroundAdherence is critical for the effectiveness of antiretroviral HIV therapy (ART), accordingly decreasing the opportunistic diseases and increasing the quality of life. Neurocognitive disorders (NCD) are still frequent in ART era and could impair the adherence, but how ethical is to refer ART in patients with NCD?ObjectiveTo assess the relation between NCD and adherence in HIV Romanian patients.Material and methodsCross‐sectional screening study on 151 patients under ART, no drug users, from HIV Clinic ‐ Galati, assessed by HIV‐Associated Dementia Scale (HDS), Hospital Anxiety and Depression Scale (HADS) [1], ART CNS‐effectiveness Letendre scores [2] and adherence assessment questionnaire CNLAS‐ Romania. Normal values: HDS >10; anxiety/ depression <8. Statistical analysis performed: Chi‐square test and Mann‐Whitney test, with 5% significance level.ResultsCharacteristics of the patients: median age 22 [20; 56] years old; sex ratio F/M 1.17; median educational level 8 [0; >12] years; HBV co‐infection 27.8%; AIDS stage 85.3%; current median CD4 526/mm3 [8; 1605] and 65% undetectable HIV‐RNA levels. 49.6% (75/151) patients attain HDS scores <10 and imply probable NCD. Scores below 8 for anxiety are more frequent than for depression: 24% vs 13%. The median ART CNS penetration score is 8 [5; 12]. Adherence is considered for 66% patients and is correlating with CD4 number (p=0.001), educational level >4 years (p=0.001; OR=4.2), HDS >10 (p=0.01; OR=2.4) and ART‐CNS penetration score >7 (p=0.023; OR=2.4). Low HDS are influenced by old age (p=0.003), depression (p=0.02) and ART‐CNS penetration scores <7 (p=0.01). Anxiety is related neither with adherence nor with NCD by HDS, but females are obvious anxious than males (p<0.001).ConclusionsBasic educational level is sufficient for developing ART adherence. High scores of HDS screening should be predictors for ART adherence. Referring ART as well to patients with low HDS scores is rational and ethical, if joint actions of effective ART‐CNS regimens and depression improvement strategy are considered.