The relationship between neuropsychological functioning and HAART adherence in HIV-positive adults: a systematic review

Combination antiretroviral therapy has helped extend the lives of persons infected with HIV; however, the efficacy of highly active antiretroviral therapy (HAART) regimens depends, in part, on the consistency with which the medications are taken. In this paper, we review 11 empirical studies conducted in Western developed nations that utilized psychometrically valid neuropsychological measures to examine the relationship between cognitive functioning and HAART adherence. In general, impaired neuropsychological functioning—particularly within the domains of executive functioning and problem solving, learning and memory, attention and working memory, and global cognitive functioning—was associated with lower medication adherence across studies. However, inconsistent operationalizations of neuropsychological impairment and medication adherence employed in these studies, as well as the paucity of longitudinal data to support temporal relationships, may attenuate these conclusions. We conclude with a set of research recommendations that may help to improve the rigor of future studies and clarify questions left unanswered due to methodological limitations of existing studies.