Executive Functioning, Cigarette Smoking, and Medication Adherence in People Living with HIV/AIDS

Abstract

Purpose. Many people living with HIV/AIDS (PLWHA) are cigarette smokers, more than three times the rate of smoking in the general population, and smoking has been associated with poor medication adherence in PLWH. Smoking has also been associated with deficits in executive functioning. Poor executive functioning is an important factor in PLWHA, as it has been also associated with poorer medication adherence. The goal of this study was to evaluate the relationships among executive functioning, smoking status, and adherence to antiretroviral medication in PLWHA. The purpose was to examine whether smoking was associated with poorer medication adherence, similar to past research, and to examine the possible mediating role of executive functioning. Methods. This between-subjects study examined the impact of cigarette smoking status (smokers, non-smokers) and executive functioning (measured by the Wisconsin Card Sorting Test-64) on medication adherence (pharmacy-based medication refill history, self-report questionnaire) in a sample of adult PLWHA ages 40-59. This study consisted of one study appointment followed by medical and pharmacy record review. Results. Cigarette smoking was not found to be significantly associated with either pharmacy-based or self-report-based medication adherence or executive functioning. Further, executive functioning was not significantly associated with medication adherence, nor did executive functioning mediate the relationship between current smoking and medication adherence. Clinical and subclinical levels of anxiety and depression symptoms were associated with poorer self-report-based medication adherence. Conclusions. Depressive and anxiety symptoms, even at subclinical levels, were associated with poorer medication adherence. The overall sample demonstrated poor cognitive performance on a measure of executive functioning, which is associated with a number of poor outcomes in PLWHA. It may be useful for healthcare professionals to assess for anxiety and/or depressive symptoms, as well as neurocognitive impairments, to identify at-risk individuals and provide appropriate interventions or treatments to improve mood, medication adherence, and functional abilities. Future studies examining the effects of these factors in larger, more representative samples of PLHWA may provide additional insight regarding how mood symptoms, smoking, and neurocognitive impairment might be impacting these individuals and their long-term health outcomes including medication adherence.