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To the Editor:
In their study, Hinkin et al.1 found a greater risk of poor adherence to highly active antiretroviral therapy (HAART) in HIV-infected persons with neuropsychological impairment. Although this finding represents an important step further in HAART adherence research, it might mostly be relevant for some subgroups of HIV-positive persons among which prevalence of neuropsychological impairment is likely to be higher: those who are treatment-naive, who have AIDS-associated neurologic disorders, or who belong to more advanced age groups. We conducted a study to examine the association between depressive symptoms, neurocognitive impairment, and HAART adherence. All HAART-treated persons observed between November 1999 and February 2000 enrolled in the Italian Cohort Naïve Antiretrovirals (ICONA) study and participating in both the nested studies on adherence (AdICONA) and on neuropsychological function (NeuroICONA) were included in this cross-sectional analysis. Adherence was investigated by a self-administered questionnaire and participants who reported missing at least one dose during the last week were considered nonadherent. Neuropsychiatric assessment included the Montgomery-Asberg Depression Rating Scale (MADRS) and the following neuropsychological test battery: motor speed (Timed Gait), fine motor control, selective attention and short-term memory (Digit Symbol subtest), verbal production (Verbal Fluency Test), verbal memory (Auditory Verbal Learning Test, …
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