Relationships between antiretroviral treatment adherence and neuro-cognitive functioning among HIV-positive adults who abuse alcohol

Background: Neuro-cognitive impairment (NCI) may be an important factor in efforts to improve antiretroviral treatment (ART) adherence in HIV-positive, alcohol-abusing populations. Methods: Measures of NCI included Color Trails Test 2 (CTT2); Short Category Test (SCT); and the Rey Auditory Verbal Learning Test (AVLT). Alcohol use severity was measured using the Alcohol use Disorders Identification Test (AUDIT) and adherence was a self-reported percentage over 7-days. Data was gathered from 171 HIV-positive adults in Miami, FL who reported recent alcohol use—the majority were male (61%) and of minority race/ethnicity (85%); mean age was 45.9; 72.5% reported 100% adherence; and 45.6% did not complete high school. NCI data was normed for age, gender, and education. Significant (p<0.1) factors from bivariate linear regression were run in a multivariate linear regression. Results: A mean AUDIT score of 15.7 indicated hazardous drinking. Means of raw SCT (40.1), AVLT (9.2), and CTT2 (58.2) exceeded healthy norms and indicated possible impairment. In bivariate regression, greater age (p=.003) and lower education level (p=0.49) predicted ART adherence. Both factors predicted adherence in a multivariate model: greater age (p=.002; CI= .23, .048, β=0.64) and lower years of education (p=.038; CI=-5.4, -0.16; β=-2.8). Neither model indicated a relationship between NCI and ART adherence. Conclusions: While NCI may seriously impact HIV-positive adults who use alcohol, other factors such as age and education may play a greater role in their degree of ART adherence. Structural equation modeling with latent variables will be conducted to further probe the relationship between NCI and adherence.