Correlates of neuropsychological functioning and associations with therapeutic alliance in HIV-infected and HIV-uninfected opiate-dependent patients

Neuropsychological (NP) impairment is multiply determined among HIV-infected and HIV-uninfected individuals who are also depressed and use illicit substances. Additionally, there is evidence that NP impairment challenges patients' ability to engage in counseling. The purpose of the present study was to assess the impact of HIV status, depression and substance use on NP performance, and to examine the effect of these factors on the therapeutic alliance between patients and their counselors. Additionally, this study examined the role of HIV status as a moderator for counselor-rated therapeutic alliance.;One hundred and sixty opiate-dependent outpatients undergoing methadone maintenance (80 HIV-infected, 80 HIV-uninfected) completed diagnostic and NP evaluations. All of the HIV-uninfected participants and 22 of the HIV-infected participants (and their counselors) completed an assessment of therapeutic alliance. Findings from individual NP tests were converted to Z scores relative to standard norms and averaged to form a composite score.;HIV-infected participants had significantly lower NP scores than HIV-uninfected participants. Only HIV status was a significant predictor of NP impairment. When the impact of HIV status, depression, substance use and NP impairment on patient- and counselor-rated alliance was evaluated, alcohol use and depression emerged as significant predictors of lower patient-rated alliance. Also, lower performance on a test of attention was a significant predictor of lower patient- and counselor-rated alliance, and lower performance on tests of verbal fluency and memory were significant predictors of lower patient-rated alliance. HIV status did not moderate the relationship between NP impairment and therapeutic alliance.;To our knowledge, this was the first study to examine the unique impact of HIV status, depression, substance use and NP functioning on therapeutic alliance, and the role of HIV status as a potential moderator for therapeutic alliance in any clinical setting. Our findings provide additional evidence for a significant role of specific NP impairment in influencing the degree to which individuals may be able to make use of their treatment resources, in this case, individual counseling. Understanding the multiple factors, including depression and substance use, that can influence engagement in treatment has the potential to lead to better interventions for patients in need.