The presence of human immunodeficiency virus-associated neurocognitive disorders is associated with a lower adherence to combined antiretroviral treatment. Open Forum Infectious Diseases
Kamal et al. investigated whether there is an association between a HIV-associated neurocognitive disorders (HAND) diagnosis and medication adherence. All patients included had a state-of-the-art neurocognitive assessment performed between January 2011 and June 2015.
Fifty-nine patients were included, with a median CD4 cell count of 603 cell/µl, a median age of 53 years, and 66% were male. 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. In addition, patients with HAND showed an increased probability of detectable HIV-RNA relative to patients without HAND.
In conclusion, the study-results indicate that the detection of neuro-cognitive disorders should raise concern that the patient may be at higher risk of viral load detection and virologic failure. For patients presenting with an increase in viral load, assessing their cognitive function should be considered. To date, the most successful interventions for preventing, delaying, or improving HAND include early initiation of and adherence to combination antiretroviral therapy.