AIDS and Behavior

, Volume 12, Issue 1, pp 68–77

Cognitive Executive Functioning in Relation to HIV Medication Adherence Among Gay, Bisexual, and other Men who have Sex with Men

Original Paper


A longitudinal study of 300 HIV-positive gay, bisexual or non-gay-identified men-who-have-sex-with-men was undertaken to consider patterns relating to HIV medication adherence. The purpose of our analyses was to consider the rate of adherence in relation to both age and executive functioning as assessed by the Trail Making Test A and B. Executive functioning was assessed at baseline and month 10. Our analytic sample consisted of 213 men who remained on the same protease inhibitor throughout the assessment timeframe. Adherence rates were relatively high with more than 50% of the sample maintaining a 95%+ adherence rate at both baseline and month 10. Analyses at baseline indicated executive functioning and age were related to rate of adherence. Analyses at month 10 indicated no significant relations. Findings support previous research and suggest that the status of executive functioning as well as age be given consideration when working with HIV-positive individuals.


HIV Treatment adherence ART Executive functioning Age Gay Bisexual MSM 


  1. Albert, S. M., Todak, G., Elkin, E., Marder, K., Dooneief, G., & Stern Y. (1994). Time allocation and disability in HIV infection: A correlational study. Journal of Occupational Science, 1, 21–30.Google Scholar
  2. Albert, S. M., Marder, K., Dooneief, G., Bell, K., Sano, M., & Todak, G. et al. (1995). Neuropsychologic impairment in early HIV infection. A risk factor for work disability. Archives of Neurology, 52(5), 525–530.Google Scholar
  3. Ammassari, A., Antinori, A., Aloisi, M. S., Trotta, M. P., Murri, R., & Bartoli, L. et al. (2004). Depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy among HIV-infected persons. Psychosomatics, 45(5), 394–402.CrossRefPubMedGoogle Scholar
  4. Ammassari, A. A., Starace, F., Aloisi, M. S., Trotta, M. P., Murri, R., & D’Arminio Monforte, A. et al. (2003). Medication adherence among HIV+ adults: Effects of cognitive dysfunction and regimen complexity. Neurology, 61(5), 723–4; author reply 724.Google Scholar
  5. Arbuthnott, K., & Frank, J. (2000). Trail making test, part B as a measure of executive control: Validation using a set-switching paradigm. Journal of Clinical and Experimental Neuropsychology: Official Journal of the International Neuropsychological Society, 22(4), 518–528.Google Scholar
  6. Army Individual Test Battery (1944). Manuel of directions and scoring. Washington, DC: War Department, Adjutant General’s Office.Google Scholar
  7. Avants, S. K., Margolin, A., Warburton, L. A., Hawkins, K. A., & Shi, J. (2001). Predictors of nonadherence to HIV-related medication regimens during methadone stabilization. The American Journal on Addictions/American Academy of Psychiatrists in Alcoholism and Addictions, 10(1), 69–78.PubMedGoogle Scholar
  8. Baldewicz, T. T., Leserman, J., Silva, S. G., Petitto, J. M., Golden, R. N., & Perkins, D. O. et al. (2004). Changes in neuropsychological functioning with progression of HIV-1 infection: Results of an 8-year longitudinal investigation. AIDS and Behavior, 8(3), 345–355.CrossRefPubMedGoogle Scholar
  9. Bondi, M. W., Drake, A. I., & Grant, I. (1998). Verbal learning and memory in alcohol abusers and polysubstance abusers with concurrent alcohol abuse. Journal of the International Neuropsychological Society: JINS, 4(4), 319–328.PubMedGoogle Scholar
  10. Bornstein, R. A., Nasrallah, H. A., Para, M. F., Whitacre, C. C., Rosenberger, P., & Fass, R. J. et al. (1992). Neuropsychological performance in asymptomatic HIV infection. The Journal of Neuropsychiatry and Clinical Neurosciences, 4(4), 386–394.PubMedGoogle Scholar
  11. Bybee, J. A., & Zigler, E. (1991). Self-image and guilt: A further test of the cognitive-developmental formulation. Journal of Personality, 59(4), 733–745.CrossRefPubMedGoogle Scholar
  12. Carrieri, P., Cailleton, V., Le Moing, V., Spire, B., Dellamonica, P., & Bouvet, E. et al. (2001). The dynamic of adherence to highly active antiretroviral therapy: Results from the french national APROCO cohort. Journal of Acquired Immune Deficiency Syndromes (1999), 28(3), 232–239.Google Scholar
  13. Cohen, R. A., Boland, R., Paul, R., Tashima, K. T., Schoenbaum, E. E., & Celentano, D. D. et al. (2001). Neurocognitive performance enhanced by highly active antiretroviral therapy in HIV-infected women. AIDS (London, England), 15(3), 341–345.Google Scholar
  14. d’Arminio Monforte, A., Lepri, A. C., Rezza, G., Pezzotti, P., Antinori, A., & Phillips, A. N. et al. (2000). Insights into the reasons for discontinuation of the first highly active antiretroviral therapy (HAART) regimen in a cohort of antiretroviral naive patients. I.CO.N.A. study group. Italian cohort of antiretroviral-naive patients. AIDS (London, England), 14(5), 499–507.Google Scholar
  15. Di Stefano, M., Monno, L., Fiore, J. R., Buccoliero, G., Appice, A., & Perulli, L. M. et al. (1998). Neurological disorders during HIV-1 infection correlate with viral load in cerebrospinal fluid but not with virus phenotype. AIDS (London, England), 12(7), 737–743.Google Scholar
  16. Ellis, R. J., Hsia, K., Spector, S. A., Nelson, J. A., Heaton, R. K., & Wallace, M. R. et al. (1997). Cerebrospinal fluid human immunodeficiency virus type 1 RNA levels are elevated in neurocognitively impaired individuals with acquired immunodeficiency syndrome. HIV neurobehavioral research center group. Annals of Neurology, 42(5), 679–688.CrossRefPubMedGoogle Scholar
  17. Ferrando, S., van Gorp, W., McElhiney, M., Goggin, K., Sewell, M., & Rabkin, J. (1998). Highly active antiretroviral treatment in HIV infection: Benefits for neuropsychological function. AIDS (London, England), 12(8), F65–F70.Google Scholar
  18. Ferrando, S. J., Rabkin, J. G., van Gorp, W., Lin, S. H., & McElhiney, M. (2003). Longitudinal improvement in psychomotor processing speed is associated with potent combination antiretroviral therapy in HIV-1 infection. The Journal of Neuropsychiatry and Clinical Neurosciences, 15(2), 208–214.PubMedGoogle Scholar
  19. Gass, C. S., & Daniel, S. K. (1990). Emotional impact on trail making test performance. Psychological Reports, 67(2), 435–438.CrossRefPubMedGoogle Scholar
  20. Gaudino, E. A., Geisler, M. W., & Squires, N. K. (1995). Construct validity in the trail making test: What makes part B harder? Journal of Clinical and Experimental Neuropsychology: Official Journal of the International Neuropsychological Society, 17(4), 529–535.Google Scholar
  21. Goodkin, K., Wilkie, F. L., Concha, M., Hinkin, C. H., Symes, S., & Baldewicz, T. T. et al. (2001). Aging and neuro-AIDS conditions and the changing spectrum of HIV-1-associated morbidity and mortality. Journal of Clinical Epidemiology, 54(Suppl. 1), S35–S43.CrossRefPubMedGoogle Scholar
  22. Gross, R., Bilker, W. B., Friedman, H. M., & Strom, B. L. (2001). Effect of adherence to newly initiated antiretroviral therapy on plasma viral load. AIDS (London, England), 15(16), 2109–2117.Google Scholar
  23. Halkitis, P. N., Kutnick, A. H., & Slater, S. (2005). The social realities of adherence to protease inhibitor regimens: Substance use, health care and psychological states. Journal of Health Psychology, 10(4), 545–558.CrossRefPubMedGoogle Scholar
  24. Heaton, R. K., Grant, I., Butters, N., White, D. A., Kirson, D., & Atkinson, J. H. et al. (1995). The HNRC 500–Neuropsychology of HIV infection at different disease stages. HIV neurobehavioral research center. Journal of the International Neuropsychological Society: JINS, 1(3), 231–251.PubMedCrossRefGoogle Scholar
  25. Heaton, R. K., Marcotte, T. D., Mindt, M. R., Sadek, J., Moore, D. J., & Bentley, H. et al. (2004). The impact of HIV-associated neuropsychological impairment on everyday functioning. Journal of the International Neuropsychological Society: JINS, 10(3), 317–331.CrossRefPubMedGoogle Scholar
  26. Hill, Z., Kendall, C., & Fernandez, M. (2003). Patterns of adherence to antiretrovirals: Why adherence has no simple measure. AIDS Patient Care and STDs, 17(10), 519–525.CrossRefPubMedGoogle Scholar
  27. Hinkin, C. H., Castellon, S. A., Durvasula, R. S., Hardy, D. J., Lam, M. N., & Mason, K. I. et al. (2002). Medication adherence among HIV+ adults: Effects of cognitive dysfunction and regimen complexity. Neurology, 59(12), 1944–1950.PubMedGoogle Scholar
  28. Hinkin, C. H., Hardy, D. J., Mason, K. I., Castellon, S. A., Durvasula, R. S., & Lam, M. N. et al. (2004). Medication adherence in HIV-infected adults: Effect of patient age, cognitive status, and substance abuse. AIDS (London, England), 18(Suppl. 1), S19–S25.Google Scholar
  29. Hugen, P. W., Langebeek, N., Burger, D. M., Zomer, B., van Leusen, R., & Schuurman, R. et al. (2002). Assessment of adherence to HIV protease inhibitors: Comparison and combination of various methods, including MEMS (electronic monitoring), patient and nurse report, and therapeutic drug monitoring. Journal of Acquired Immune Deficiency Syndromes (1999), 30(3), 324–334.Google Scholar
  30. Kalichman, S. C., Difonzo, K., Austin, J., Luke, W., & Rompa, D. (2002). Prospective study of emotional reactions to changes in HIV viral load. AIDS Patient Care and STDs, 16(3), 113–120.CrossRefPubMedGoogle Scholar
  31. Kimmerling, M., Wagner, G., & Ghosh-Dastidar, B. (2003). Factors associated with accurate self-reported adherence to HIV antiretrovirals. International Journal of STD and AIDS, 14(4), 281–284.CrossRefPubMedGoogle Scholar
  32. Kortte, K. B., Horner, M. D., & Windham, W. K. (2002). The trail making test, part B: Cognitive flexibility or ability to maintain set? Applied Neuropsychology, 9(2), 106–109.CrossRefPubMedGoogle Scholar
  33. Kruse, W., Rampmaier, J., Ullrich, G., & Weber, E. (1994). Patterns of drug compliance with medication to be taken once and twice daily assessed by continuous electronic monitoring in primary care. International Journal of Clinical Pharmacology Therapy, 32, 453–457.Google Scholar
  34. Lezak, M. D. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford University Press.Google Scholar
  35. Liu, H., Golin, C. E., Miller, L. G., Hays, R. D., Beck, C. K., & Sanandaji, S. et al. (2001). A comparison study of multiple measures of adherence to HIV protease inhibitors. Annals of Internal Medicine, 134(10), 968–977.PubMedGoogle Scholar
  36. Mannheimer, S., Friedland, G., Matts, J., Child, C., & Chesney, M. (2002). The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus-infected persons in clinical trials. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 34(8), 1115–1121.Google Scholar
  37. Matsuyama, J. R., Mason, B. J., & Jue, S. G. (1993). Pharmacists’ interventions using an electronic medication-event monitoring device’s adherence data versus pill counts. The Annals of Pharmacotherapy, 27(7–8), 851–855.PubMedGoogle Scholar
  38. McArthur, J. C., McClernon, D. R., Cronin, M. F., Nance-Sproson, T. E., Saah, A. J., & St Clair, M. et al. (1997). Relationship between human immunodeficiency virus-associated dementia and viral load in cerebrospinal fluid and brain. Annals of Neurology, 42(5), 689–698.CrossRefPubMedGoogle Scholar
  39. Miller, E. N., Selnes, O. A., McArthur, J. C., Satz, P., Becker, J. T., & Cohen, B. A. et al. (1990). Neuropsychological performance in HIV-1-infected homosexual men: The multicenter AIDS cohort study (MACS). Neurology, 40(2), 197–203.PubMedGoogle Scholar
  40. Palella, F. J. Jr., Delaney, K. M., Moorman, A. C., Loveless, M. O., Fuhrer, J., & Satten, G. A. et al. (1998). Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient study investigators. The New England Journal of Medicine, 338(13), 853–860.CrossRefPubMedGoogle Scholar
  41. Parsons, T. D., Braaten, A. J., Hall, C. D., & Robertson, K. R. (2006). Better quality of life with neuropsychological improvement on HAART. Health and Quality of Life Outcomes [Electronic Resource], 4, 11.CrossRefGoogle Scholar
  42. Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., & Squier, C. et al. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133(1), 21–30.PubMedGoogle Scholar
  43. Power, R., Koopman, C., Volk, J., Israelski, D. M., Stone, L., & Chesney, M. A. et al. (2003). Social support, substance use, and denial in relationship to antiretroviral treatment adherence among HIV-infected persons. AIDS Patient Care and STDs, 17(5), 245–252.CrossRefPubMedGoogle Scholar
  44. Rabkin, J. G., & Chesney, M. (1999). Treatment adherence to HIV medications: The Achilles heel of new therapeutics. In D. Ostrow, S. Kalichman (Eds.), New HIV therapies: Psychology and public health implications. New York: Plenum Press.Google Scholar
  45. Reger, M., Welsh, R., Razani, J., Martin, D. J., & Boone, K. B. (2002). A meta-analysis of the neuropsychological sequelae of HIV infection. Journal of the International Neuropsychological Society: JINS, 8(3), 410–424.CrossRefPubMedGoogle Scholar
  46. Reitan, R., & Wolfson, D. (1993). The helstead-reitan neuropsychological test battery: Theory and clinical interpretation. Tucson, AZ: Neuropsychological Press.Google Scholar
  47. Rosselli, M., & Ardila, A. (1996). Cognitive effects of cocaine and polydrug abuse. Journal of Clinical and Experimental Neuropsychology: Official Journal of the International Neuropsychological Society, 18(1), 122–135.Google Scholar
  48. Sankar, A., Golin, C., Simoni, J. M., Luborsky, M., & Pearson, C. (2006). How qualitative methods contribute to understanding combination antiretroviral therapy adherence. Journal of Acquired Immune Deficiency Syndromes (1999), 43(Suppl. 1), S54–S68.CrossRefGoogle Scholar
  49. Shannon, K., Kerr, T., Lai, C., Ishida, T., Wood, E., & Montaner, J. S. et al. (2005). Nonadherence to antiretroviral therapy among a community with endemic rates of injection drug use. Journal of the International Association of Physicians in AIDS Care (Chicago, IL: 2002), 4(3), 66–72.CrossRefGoogle Scholar
  50. Starace, F., Bartoli, L., Aloisi, M. S., Antinori, A., Narciso, P., & Ippolito, G. et al. (2002). Cognitive and affective disorders associated to HIV infection in the HAART era: Findings from the NeuroICONA study. Cognitive impairment and depression in HIV/AIDS. the NeuroICONA study. Acta Psychiatrica Scandinavica, 106(1), 20–26.CrossRefPubMedGoogle Scholar
  51. Tombaugh, T. N. (2004). Trail making test A and B: Normative data stratified by age and education. Archives of Clinical Neuropsychology: The Official Journal of the National Academy of Neuropsychologists, 19(2), 203–214.Google Scholar
  52. Tozzi, V., Balestra, P., Galgani, S., Narciso, P., Sampaolesi, A., & Antinori, A. et al. (2001). Changes in neurocognitive performance in a cohort of patients treated with HAART for 3 years. Journal of Acquired Immune Deficiency Syndromes (1999), 28(1), 19–27.Google Scholar
  53. Tozzi, V., Balestra, P., Murri, R., Galgani, S., Bellagamba, R., & Narciso, P. et al. (2004). Neurocognitive impairment influences quality of life in HIV-infected patients receiving HAART. International Journal of STD and AIDS, 15(4), 254–259.CrossRefPubMedGoogle Scholar
  54. Treisman, G. J., Angelino, A. F., & Hutton, H. E. (2001). Psychiatric issues in the management of patients with HIV infection. JAMA: The Journal of the American Medical Association, 286(22), 2857–2864.CrossRefGoogle Scholar
  55. Turner, C. F., Ku, L., Rogers, S. M., Lindberg, L. D., Pleck, J. H., & Sonenstein, F. L. (1998). Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology. Science, 280(5365), 867–873.CrossRefPubMedGoogle Scholar
  56. Valcour, V., & Paul, R. (2006). HIV infection and dementia in older adults. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 42(10), 1449–1454.Google Scholar
  57. Wagner, G. J. (2002). Predictors of antiretroviral adherence as measured by self-report, electronic monitoring, and medication diaries. AIDS Patient Care and STDs, 16(12), 599–608.CrossRefPubMedGoogle Scholar
  58. Wagner, G. J., & Rabkin, J. G. (2000). Measuring medication adherence: Are missed doses reported more accurately then perfect adherence? AIDS Care, 12(4), 405–408.CrossRefPubMedGoogle Scholar
  59. Wainberg, M. A., & Friedland, G. (1998). Public health implications of antiretroviral therapy and HIV drug resistance. JAMA: The Journal of the American Medical Association, 279(24), 1977–1983.CrossRefGoogle Scholar
  60. Waterhouse, D. M., Calzone, K. A., Mele, C., & Brenner, D. E. (1993). Adherence to oral tamoxifen: A comparison of patient self-report, pill counts, and microelectronic monitoring. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 11(6), 1189–1197.Google Scholar
  61. Watters, J. K., & Biernacki, P. (1989). Targeted sampling: Options and considerations for the study of hidden populations. Social Problems, 36, 416–430.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.New York University School of MedicineNew YorkUSA
  2. 2.Center for Health, Identity, Behavior & Prevention Studies (CHIBPS)New York University Steinhardt School of Culture, Education, and Human DevelopmentNew YorkUSA

Personalised recommendations