HIV/Bipolar disorder: Implications for medication adherence

David J. Moore, UC San Diego

Individuals with bipolar disorder (BD) are at high risk for chronic medical illnesses such as HIV infection, but relatively few prospective studies have been conducted with persons with both BD and HIV infection (BD+/HIV+). Successful treatment of HIV infection requires managing complex antiretroviral (ARV) medication regimens. Having a serious mental illness such as BD may make adherence to medications more difficult for several reasons including mood symptoms, substance use, and cognitive problems. Poor adherence to ARV medications may lead to faster progression of HIV illness and hasten the development of treatment resistant HIV strains.

The current UARP study is designed to address the following primary aims:

  1. to determine whether BD+/HIV+ individuals have more severe cognitive impairment, worse medication management abilities, and worse ARV medication adherence than individuals with HIV infection alone (BD-/HIV+), and
  2. to identify significant predictors of medication management ability and ARV adherence among BD+/HIV+ individuals.

To address these goals, we will recruit and assess 40 BD+/HIV+ and 40 BD-/HIV+ adult outpatients. We will assess neurocognitive ability with a comprehensive neuropsychological test battery, medication management with a standardized, performance-based measure, and medication adherence with self- and collateral report. Psychiatric symptoms, substance use, and attitudes toward medications will also be obtained as possible predictors of medication management ability and ARV adherence. We will also conduct individual qualitative interviews with BD+/HIV+ individuals to better understand the barriers to, and strategies for, successful medication adherence. Results from this study will provide necessary information about whether BD increases risk for more severe cognitive impairment, worse medication management ability, and worse ARV adherence. Furthermore, this study will inform the development of a targeted psychosocial intervention for improving medication adherence among BD+/HIV+ individuals (in light of the high likelihood that these individuals have unique needs as compared to other HIV infected individuals).