The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus.

Violet Awori,Peter Mativo,Gerald Yonga,Reena C Shah

doi:10.4102/sajhivmed.v19i1.674

Abstract

BackgroundAsymptomatic cognitive impairment in human immunodeficiency virus (HIV)-infected patients has recently been recognised as part of HIV-associated neurocognitive disorders. This has been implicated as one of the causes of poor adherence to antiretroviral therapy (ART).ObjectiveTo assess the association between neurocognitive impairment (asymptomatic and mild forms) and adherence to ART.MethodsThis was a cross-sectional survey involving 218 participants consecutively sampled from those attending the HIV treatment clinic at Aga Khan University Hospital in Nairobi. Data collected included quantitative primary data on pre-defined baseline characteristics, neurocognitive assessment by Montreal Cognitive Assessment (MoCA) tool (Appendix 1), instrumental activities of daily living by Lawton score and objective and subjective adherence measures by medication possession ratio (MPR) and simplified medication adherence questionnaire (SMAQ) (see Appendix 2). Univariate and bivariate analyses were conducted to determine the strengths of association between predictor and the outcome variables.ResultsAmong the 218 participants in the study, a total of 69% had asymptomatic to mild neurocognitive impairment as assessed by the MoCA tool, while a total of 66% were determined as being adherent to ART by objective measures (by MPR) compared to subjective rates of 77% as assessed by SMAQ. However, no statistically significant association was observed between the presence of asymptomatic or mild neurocognitive impairment and likelihood of adherence to ART (p > 0.05).ConclusionEven though asymptomatic and mild forms of cognitive impairment are prevalent in the population studied, there was no significant association between cognitive impairment and adherence to treatment.

Highlights

Human immunodeficiency virus (HIV) is associated with neurological complications, including neurocognitive impairment
Of the 218 participants selected for the study, a total of 215 completed the MoCA neurocognitive assessment
The study population varied according to different baseline demographic and HIV treatment-related characteristics (Tables 1 and 2)

Summary

Introduction

Human immunodeficiency virus (HIV) is associated with neurological complications, including neurocognitive impairment. The widely used screening tests, such as the International HIV Dementia Scale (IHDS), mainly assess cortical function and are not sensitive to the milder forms of neurocognitive impairment. Advisory documents indicate that an adherence rate of 95% is necessary for successful viral suppression.[5,6] There are many causes of poor adherence, some of which are attributed to neurocognitive impairment that may be asymptomatic or mild, and go clinically unrecognised if not assessed.[3]. Asymptomatic cognitive impairment in human immunodeficiency virus (HIV)infected patients has recently been recognised as part of HIV-associated neurocognitive disorders. This has been implicated as one of the causes of poor adherence to antiretroviral therapy (ART)

Methods

Results

Conclusion