ADHD as a Potential Risk Factor in Poor Antiretroviral Adherence Rates in HIV: A Brief Narrative Review and Suggestions for Future Research

This was a narrative review of the literature pertaining to antiretroviral adherence rates in patients with HIV, with a focus on ADHD as a potential risk for poor adherence. A connection is drawn between the cognitive symptoms of ADHD and risk factors for poor treatment adherence in HIV. Parallel associations between ADHD and poor treatment adherence in patients with diabetes are also discussed. Finally, some of the challenges in measuring medication adherence in patients with HIV are summarized. Future research may assess whether patients with comorbid ADHD and HIV have lower rates of adherence than those with HIV alone. Samples will need to be large to manage other contributing factors such as age; in our clinic, patients with HIV referred for ADHD evaluations tend to be younger than patients with HIV referred for assessment of other neurocognitive conditions. This artifact confounds attempts to compare adherence rates in patients with both ADHD and HIV versus those without, as younger age is independently associated with poorer medication compliance. Future research should also include the development of strategies to help infectious disease clinicians to measure adherence as well as the development of cognitive and behavioral strategies for improving adherence rates in patients at risk for poor medication compliance.