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AIDS Patients' Forgetfulness Means Skipped Medication

... And that can worsen the disease

MONDAY, Dec. 23, 2002 (HealthDayNews) -- Researchers are developing more insight into a crippling Catch-22 of AIDS: Patients who develop mental deficits are more likely to forget to take their pills, setting themselves up for a worsening of the disease -- and more cognitive decline.

According to a new study, 70 percent of AIDS patients with cognitive (judgmental) impairments couldn't manage to take their medications on a regular basis, and they had an especially hard time when three daily doses were required. By contrast, 82 percent of patients with no mental impairments took their medications as directed.

"Medication adherence is essential, and we need to do whatever we can to improve it in HIV infected patients," said the study's author, Dr. Charles Hinkin, an associate professor of psychiatry at the University of California at Los Angeles School of Medicine.

Medicine has made great strides in the treatment of AIDS in the past decade. Thanks to powerful drug therapy, many patients are no longer at the brink of death.

But even if it's less deadly, AIDS can still be devastating to patients who don't respond to treatment. The disease is especially hard on the brain, which falls victim to inflammation as the body tries to attack the AIDS virus, said Dr. Robert Grant, an investigator with the Gladstone Institute of Virology and Immunology at the University of California at San Francisco.

"The immune system is attempting to clear HIV-infected cells, and in the process uninfected cells -- innocent bystanders -- are getting damaged in this huge battle," he said.

As a result, AIDS patients often suffer from such mental lapses as forgetfulness, difficulty concentrating and paying attention.

California researchers decided to examine how these deficits affect the ability of patients to take AIDS drugs correctly. AIDS patients who forget to take doses of their medication can put themselves in danger because the medication works to prevent the virus from mutating into newer, more powerful forms.

In their study, researchers looked at 137 patients who were taking the so-called AIDS cocktail -- a mixture of several different drugs -- in the Los Angeles area.

The findings appear in the Dec. 24 issue of Neurology, the scientific journal of the American Academy of Neurology.

Researchers found that patients with cognitive decline had an especially hard time remembering to take three daily doses of pills. They did so only 52 percent of the time, compared to 79 percent for the other patients.

"That midday dose is what trips people up," Hinkin said. "People are better able to remember to take their doses in the morning and evening."

Part of the problem is the number of pills that AIDS patients must take. They can go as high as 20 to 30 pills a day, Hinkin said, a big challenge for those with cognitive deficits.

Also, patients may not have the brain power to set up ways to remind themselves to take their pills. "They need to have some sort of reminder -- a pill box timer, a yellow sticky note on a bathroom mirror, a loved one to ask if they've taken their medicine," he added.

Surprisingly, the oldest patients without cognitive deficits -- those over 50 -- were most likely to take their medications as directed, Hinkin said. "They may have had prior experience taking medicine for things like hypertension, so it's not as much of a new behavior."

The study reinforces the idea that doctors need to take mental acuity into account when they prescribe drugs for AIDS patients, Hinkin said, noting, "One size fits all is probably not going to work."

However, drug companies are working to develop AIDS medications that can be taken as infrequently as once a day.

What To Do

Learn more about HIV from the CDC's Divisions of HIV/AIDS Prevention and AIDS Action.

SOURCES: Charles Hinkin, M.D., associate professor of psychiatry, University of California at Los Angeles School of Medicine; Robert Grant, M.D., investigator, Gladstone Institute of Virology and Immunology, University of California at San Francisco; Dec. 24, 2002, Neurology.

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