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Neurocognitive impairment and medication adherence in HIV patients with and without cocaine dependence

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Abstract

Cocaine abuse among HIV patients is associated with faster disease progression and mortality. This study examined the relationship between neurocognitive functioning and medication adherence in HIV patients with (n = 25) and without (n = 39) current cocaine dependence. Active users had greater neurocognitive impairment (mean T-score = 35.16 vs. 40.97, p < .05) and worse medication adherence (mean z-score = −0.44 vs. 0.27, p < .001). In a multiple regression model, neurocognitive functioning (β = .33, p < .01) and cocaine dependence (β = −.36, p < .01) were predictive of poorer adherence. There was a significant indirect effect of cocaine dependence on medication adherence through neurocognitive impairment (estimate = −0.15, p < .05), suggesting that neurocognitive impairment partially mediated the relationship between cocaine dependence and poorer adherence. These results confirm that cocaine users are at high risk for poor HIV outcomes and underscore the importance of treating both neurocognitive impairment and cocaine dependence among HIV patients.

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Acknowledgments

This study was supported by grants from amfAR, The Foundation for AIDS Research (106884-42-RFBR), the National Institute on Drug Abuse (T32-DA01536), the Harvard University Center for AIDS Research (P30-AI60354), and the Duke University Center for AIDS Research (P30-AI064519). The authors thank Drs. Scott Lukas and Kathleen Sikkema for their mentorship and Mary Key, Jessica Eldridge, Ross MacLean, and Tiffany Chu for their assistance collecting and entering data.

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Authors and Affiliations

  1. Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 90519, Durham, NC, 27708, USA

    Christina S. Meade

  2. Duke Global Health Institute, Durham, NC, USA

    Christina S. Meade & Linda M. Skalski

  3. Behavioral Psychopharmacology Research Laboratory, McLean Hospital, Belmont, MA, USA

    Christina S. Meade & Nina A. Conn

  4. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Christina S. Meade & Steven A. Safren

  5. Behavioral Medicine Service, Massachusetts General Hospital, Boston, MA, USA

    Steven A. Safren

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Correspondence to Christina S. Meade.

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Meade, C.S., Conn, N.A., Skalski, L.M. et al. Neurocognitive impairment and medication adherence in HIV patients with and without cocaine dependence. J Behav Med 34, 128–138 (2011). https://doi.org/10.1007/s10865-010-9293-5

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  • DOI: https://doi.org/10.1007/s10865-010-9293-5

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