Medical News

Adherence to HIV Antiretrovirals Among Persons With Serious Mental Illness

August 11, 2003

This article is part of The Body PRO's archive. Because it contains information that may no longer be accurate, this article should only be considered a historical document.

One drawback to HAART is the need for near-perfect adherence to the regimen. Providers assume that patients with serious mental illness are at an especially high risk for nonadherence. The current study assesses adherence rates to HIV antiretroviral regimens among patients with serious mental illness (schizophrenia, schizoaffective disorder, bipolar depression, and major depression with psychotic features). The study was conducted over a two-week period using electronic monitoring caps and self-reporting in a Los Angeles community-based sample of persons with serious mental illness.

Subjects brought their antiretroviral medications to the baseline visit, where they were given a medicine bottle with a microelectronic chip in the cap. Participants dispensed a two-week supply of their most complex medication into the bottle, and researchers told them the chip would record the date and time of each bottle opening. They were instructed to open the bottle containing the selected medication only when preparing to take a dose, and to remove only one dose at a time. Researchers also gathered demographic information (age, gender, ethnicity/race, education, housing accommodations and household composition, employment status, income, and relationship status) and drew blood specimens to be used to perform assays for CD4 count and HIV RNA (PCR) viral load.

At the week-two visit, participants turned in their bottle caps and recalled their pill-taking behavior over the previous three days, both HIV and psychotropic medication (if applicable). Researchers asked participants about doses missed and number of days they missed taking their medications over the study period, and questioned them about their adherence strategies.

Of the 45 participants who completed the study, mean age was 41, 79 percent were male, 49 percent were Caucasian, 43 percent were African-American, and 9 percent were Latino. Twenty five percent were employed, and education ranged from 23 percent not having completed high school to 25 percent with a college degree. Eighty-one percent were single, 24 percent had unstable or temporary housing, and 66 percent identified as gay or bisexual.

The average electronically monitored adherence rate for the sample was 66 percent. Forty percent of the subjects showed at least 90 percent adherence, but nearly a third displayed less than 50 percent adherence. Mean self-reported adherence rates were 92 percent for the entire antiretroviral regimen and 93 percent for the one selected antiretroviral. Self-reported adherence to psychotropics was mildly correlated with self-reported and electronically monitored antiretroviral adherence.

The authors pointed out that theirs was the first published study to systematically evaluate adherence to HIV antiretrovirals in persons with serious mental illness. In the study's small sample, the data suggested individuals with serious mental illness are able to adhere to antiretrovirals at levels similar to other HIV populations. "Consequently," the researchers wrote, "mental illness alone is not a reason to defer or deny treatment that is otherwise medically warranted." The authors cautioned, however, that a substantial number of participants displayed poor adherence.

"Further work," they concluded, "is needed to identify barriers to adherence that may be unique to persons with serious mental illness, which could then inform the development of interventions to help those struggling with adherence to achieve optimal treatment benefits."

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Adapted from:
AIDS Patient Care and STDs
04.03; Vol. 17; No. 4: P. 179-186; Glenn J. Wagner, Ph.D.; David E. Kanouse, Ph.D.; Paul Koegel, Ph.D.; Greer Sullivan, M.D., M.S.P.H.

This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.


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