Select Abstracts from Elements of Success: An International Conference on Adherence to Antiretroviral Therapy, December 5-8, 2002, Dallas, Texas, USA

Abstract

Background: Patients with serious mental illness are presumed to be at high risk for poor adherence to HIV antiretrovirals; yet, there are no published studies of adherence to HIV medications in this population to substantiate this assumption. Methods: To assess the rates and correlates of adherence to HIV antiretrovirals in a sample of patients with serious mental illness, we conducted a study in which antiretroviral adherence was measured with electronic monitoring caps over a two-week observation period. Results: Forty-seven participants enrolled in the study. Psychiatric diagnoses included schizophrenia (n=12), schizoaffective disorder (n = 5), bipolar depression (n = 24), and major depression with psychotic features (n = 6). Mean age was 41, 79 percent were male, 23 percent did not complete high school, most were Caucasian (49 percent) or African American (43 percent), 25 percent were employed, 24 percent had temporary/unstable housing (including five participants who were homeless), and 50 percent had a history of intravenous drug use (IVDU). Mean CD4 count was 621 (SD = 335) and average viral load log was 2.7 (36 percent had an undetectable viral load). Average electronic monitored antiretroviral adherence was 66 percent (SD = 34), with 40 percent of the sample demonstrating at least 90 percent adherence. Lower adherence was significantly associated (p < .05) with higher viral load, history of IVDU, having missed recent clinic appointments, lower satisfaction with medical care and the relationship with one’s doctor, greater perceived interference in one’s life caused by treatment side effects, and alcohol and marijuana use. Conclusions: These findings suggest that as a group, persons with serious mental illness achieve an adherence level that is relatively low and similar to what other studies have found in groups suspected to be at high risk for poor adherence (active drug users, marginally housed), but the results also confirm that a large subgroup of this population are indeed able to adhere very well to antiretroviral regimens.