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HIV-Infected Individuals with Co-occurring Bipolar Disorder Evidence Poor Antiretroviral and Psychiatric Medication Adherence

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Abstract

The contribution of bipolar disorder (BD), a prevalent serious mental illness characterized by impulsivity and mood instability, to antiretroviral (ART) and psychiatric medication adherence among HIV-infected (HIV+) individuals is unknown. We examined medication adherence among 44 HIV+/BD+ persons as compared to 33 demographically- and medically-comparable HIV+/BD− persons. Classification of adherent (≥90%) or non-adherent (<90%) based on proportion of correctly taken doses over 30 days was determined using electronic medication monitoring devices. HIV+/BD+ persons were significantly less likely to be ART adherent (47.7%) as compared to HIV+/BD− (90.9%) persons. Within the HIV+/BD+ group, mean psychiatric medication adherence was significantly worse than ART medication adherence, although there was a significant correlation between ART and psychiatric adherence levels. Importantly, 30-day ART adherence was associated with plasma virologic response among HIV+/BD+ individuals. Given the high overlap of HIV and BD, and the observed medication adherence difficulties for these persons, specialized adherence improvement interventions are needed.

Resumen

La contribución de un diagnóstico de trastorno bipolar (BP), una frecuente enfermedad mental grave caracterizada por impulsividad e inestabilidad del estado de ánimo, a la adherencia a los medicamentos antirretrovirales y psiquiátricos entre las personas infectadas por el VIH es desconocida. Nosotros examinamos la adherencia a estos medicamentos en 44 individuos infectados con VIH, que también estaban diagnosticados con trastorno bipolar (VIH+/BP+) y los comparamos con 33 individuos infectados con VIH que no tenían un diagnóstico de trastorno bipolar (VIH+/BP), pero que eran comparables a éstos en sus características demográficas y médicas. La clasificación de adherentes (≥90%) o no adherentes (<90%), basado en la proporción de la dosis correcta tomada por cada individuo en el trasncurso de 30 días fue determinada usando dispositivos de monitoreo electrónico. Los individuos VIH+/BP+ fueron significativamente menos propensos a ser clasificados como adherentes a los antirretrovirales (47.7%) en comparación con los individuos VIH+/BP− (90.9%). Entre el grupo de los VIH+/BP+, el promedio de adherencia fue significativamente peor para los medicamentos psiquiátricos en comparación a los medicamentos antirretrovirales, aunque hubo una correlación significativa entre la adherencia a los medicamentos antirretrovirales y a los medicamentos psiquiátricos. Es importante destacar que la adherencia a los medicamentos antiretrovirales se asoció con la respuesta virológica en el plasma de los individuos VIH+/BP+. Debido a la alta prevalencia de VIH entre individuos diagnosticados con trastorno bipolar, y las dificultades que tienen estos individuos en la adherencia a los medicamentos, es necesario desarrollar intervenciones especializadas para mejorar la adherencia a los medicamentos en esta población.

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Acknowledgments

This work was supported by National Institute of Mental Health R03 MH078785 and the California HIV/AIDS Research Program IDEA Award ID06-SD-201. The HIV Neurobehavioral Research Center (HNRC), supported by National Institute of Mental Health Center Award P30 MH 62512, and P01 DA 012065, supported by the National Institute of Drug Abuse, also contributed participant data to this study.

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Authors and Affiliations

  1. Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA

    David J. Moore, Mili Parikh, Miguel Arce, Patricia K. Riggs, Ben Gouaux, Igor Grant & J. Hampton Atkinson

  2. Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA

    Carolina Posada

  3. Division of Biostatistics, University of California, San Diego, La Jolla, CA, USA

    Florin Vaida

  4. Department of Neurosciences, School of Medicine, University of California, San Diego, La Jolla, CA, USA

    Ronald J. Ellis

  5. Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA

    Scott L. Letendre

  6. HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B, Mail Code 8231, San Diego, CA, 92103-8231, USA

    David J. Moore

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  1. David J. Moore
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The HIV Neurobahavioral Research Program (HNRP)

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Correspondence to David J. Moore.

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The members of the HIV Neurobehavioral Research Program (HNRP) are given in Appendix.

All authors on this manuscript are also affiliated with and are part of the HIV Neurobehavioral Research Program.

Appendix

Appendix

The San Diego HIV Neurobehavioral Research Center [HNRC] group is affiliated with the University of California, San Diego, the Naval Hospital, San Diego, and the Veterans Affairs San Diego Healthcare System, and includes: Director: Igor Grant, M.D.; Co-Directors: J. Hampton Atkinson, M.D., Ronald J. Ellis, M.D., Ph.D., and J. Allen McCutchan, M.D.; Center Manager: Thomas D. Marcotte, Ph.D.; Jennifer Marquie-Beck, M.P.H.; Melanie Sherman; Neuromedical Component: Ronald J. Ellis, M.D., Ph.D. (P.I.), J. Allen McCutchan, M.D., Scott Letendre, M.D., Edmund Capparelli, Pharm.D., Rachel Schrier, Ph.D., Terry Alexander, R.N., Debra Rosario, M.P.H., Shannon LeBlanc; Neurobehavioral Component: Robert K. Heaton, Ph.D. (P.I.), Steven Paul Woods, Psy.D., Mariana Cherner, Ph.D., David J. Moore, Ph.D., Matthew Dawson; Neuroimaging Component: Terry Jernigan, Ph.D. (P.I.), Christine Fennema-Notestine, Ph.D., Sarah L. Archibald, M.A., John Hesselink, M.D., Jacopo Annese, Ph.D., Michael J. Taylor, Ph.D.; Neurobiology Component: Eliezer Masliah, M.D. (P.I.), Cristian Achim, M.D., Ph.D., Ian Everall, FRCPsych., FRCPath., Ph.D. (Consultant); Neurovirology Component: Douglas Richman, M.D., (P.I.), David M. Smith, M.D.; International Component: J. Allen McCutchan, M.D., (P.I.); Developmental Component: Cristian Achim, M.D., Ph.D.; (P.I.), Stuart Lipton, M.D., Ph.D.; Participant Accrual and Retention Unit: J. Hampton Atkinson, M.D. (P.I.), Rodney von Jaeger, M.P.H.; Data Management Unit: Anthony C. Gamst, Ph.D. (P.I.), Clint Cushman (Data Systems Manager); Statistics Unit: Ian Abramson, Ph.D. (P.I.), Florin Vaida, Ph.D., Reena Deutsch, Ph.D., Anya Umlauf, M.S., Tanya Wolfson, M.A.

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Moore, D.J., Posada, C., Parikh, M. et al. HIV-Infected Individuals with Co-occurring Bipolar Disorder Evidence Poor Antiretroviral and Psychiatric Medication Adherence. AIDS Behav 16, 2257–2266 (2012). https://doi.org/10.1007/s10461-011-0072-2

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