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Randomized Controlled Trial
. 2011 Feb 1;56(2):146-50.
doi: 10.1097/QAI.0b013e318201df63.

Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of antiretroviral therapy utilization

Adam W Carrico  1 , Elise D Riley, Mallory O Johnson, Edwin D Charlebois, Torsten B Neilands, Robert H Remien, Marguerita A Lightfoot, Wayne T Steward, Lance S Weinhardt, Jeffrey A Kelly, Mary Jane Rotheram-Borus, Stephen F Morin, Margaret A Chesney
Affiliations
Randomized Controlled Trial

Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of antiretroviral therapy utilization

Adam W Carrico et al. J Acquir Immune Defic Syndr. .

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.

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Figures

Figure 1
Figure 1
Inconsistent ART utilization patterns explain the effects of depressive symptoms and weekly stimulant use on mean HIV viral load. Total Effect = Percent increase in HIV viral load after controlling for average self-reported percentage of ART doses taken and baseline CD4+ count; Mediation Model = Inconsistent patterns of ART utilization act as a mechanisms for the effects of depressive symptoms and weekly stimulant use on higher mean HIV viral load; Mean HIV Viral Load = Average HIV viral load in the 25 months following baseline; Percentages = reflect the percent increase in the odds of inconsistent ART utilization patterns or the percent increase in mean log10 HIV viral load
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