Investigating the Interrelationships between Fatigue, Memory Impairment, and Medication Adherence among Persons Living with HIV Disease



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Fatigue and memory impairment are each highly prevalent in HIV disease (e.g., Heaton et al., 2011; Jong et al., 2010), and exert independent influences on adherence to antiretroviral therapy. However, the combined effects of fatigue and memory impairments on adherence, as well as possible modulating factors of these effects, remain unknown. This study adopted the Aaronson et al. (1999) model of fatigue, which predicts that fatigue depletes compensatory resources, thus leaving HIV+ individuals vulnerable to the impact of memory impairment on adherence. The first aim was to determine the best-fitting model of the relationships between fatigue, compensatory strategy use, retrospective and prospective memory, and adherence. The second aim was to assess whether changes in fatigue, strategy use, and memory were associated with changes in perceived medication management efficacy over one year. Study participants included 177 HIV+ persons who completed a semi-structured clinical interview, comprehensive neurocognitive battery, a series of questionnaires, and a physical evaluation. cART adherence was obtained behaviorally with MEMS caps and by self-report of medication management. Readministration of these assessments (except for the MEMS) was conducted with 57 participants at follow-up about one year later. Structural equation modeling revealed that adherence was most parsimoniously represented by contributions from measures of perceived medication management efficacy and MEMS. In the first aim, the data were fit best by a model comprised of direct and covarying negative effects of fatigue and strategy use on adherence, which were independent from a direct positive effect of prospective memory (controlled for retrospective memory) on adherence. In the second aim, data were fit best by a model comprised of changes in fatigue and strategy use, but not prospective memory, as significant covariates of change in perceived medication management efficacy. These data revealed dynamic interplay between fatigue, strategy use, and perceived efficacy, with separate and stable contributions of prospective memory to perceived efficacy. These and prior findings are discussed in the context of metacognitive awareness. Ultimately, enhanced understanding of these relationships provides valuable clinical information that can inform efforts to (1) improve patient-specific targeting of fatigue-related assessments and interventions; and (2) develop effective interventions for bolstering adherence in seropositive populations.



HIV, HIV-associated fatigue, HIV-associated neurocognitive disorders, HAND, Prospective memory, Retrospective memory, Compensatory strategy use