Faculty Collaboration Database

Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of antiretroviral therapy utilization. J Acquir Immune Defic Syndr 2011 Feb 01;56(2):146-50

Date

12/01/2010

Pubmed ID

21116186

Pubmed Central ID

PMC3494991

DOI

10.1097/QAI.0b013e318201df63

Scopus ID

2-s2.0-78751608934 (requires institutional sign-in at Scopus site)   112 Citations

Abstract

BACKGROUND: In the era of antiretroviral therapy (ART), depression and substance use predict hastened HIV disease progression, but the underlying biological or behavioral mechanisms that explain these effects are not fully understood.

METHODS: Using outcome data from 603 participants enrolled in a randomized controlled trial of a behavioral intervention, binary logistic and linear regression were employed to examine whether inconsistent patterns of ART utilization partially mediated the effects of depression and substance use on higher HIV viral load over a 25-month follow-up.

RESULTS: Elevated affective symptoms of depression independently predicted ART discontinuation [adjusted odds ratio = 1.39, 95% confidence interval (CI) = 1.08 to 1.78], and use of stimulants at least weekly independently predicted intermittent ART utilization (adjusted odds ratio = 2.62, 95% CI = 1.45 to 4.73). After controlling for the average self-reported percentage of ART doses taken and baseline T-helper (CD4) count, elevated depressive symptoms predicted a 50% higher mean viral load, and weekly stimulant use predicted a 137% higher mean viral load. These effects became nonsignificant after accounting for inconsistent patterns of ART utilization, providing evidence of partial mediation.

CONCLUSIONS: Inconsistent patterns of ART utilization may partially explain the effects of depression and stimulant use on hastened HIV disease progression.

Author List

Carrico AW, Riley ED, Johnson MO, Charlebois ED, Neilands TB, Remien RH, Lightfoot MA, Steward WT, Weinhardt LS, Kelly JA, Rotheram-Borus MJ, Morin SF, Chesney MA

Authors

Jeffrey A. Kelly PhD Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Lance S. Weinhardt MS,PhD Associate Dean for Research and Professor of Community and Behavioral Health Promotion in the Joseph. J. Zilber School of Public Health department at University of Wisconsin - Milwaukee

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Anti-HIV Agents
Antiretroviral Therapy, Highly Active
Depression
Disease Progression
Female
HIV Infections
Humans
Male
Medication Adherence
Middle Aged
Risk Factors
Substance-Related Disorders