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. 2020 Aug 19:11:834.
doi: 10.3389/fpsyt.2020.00834. eCollection 2020.

Posttraumatic Stress Disorder and Nonadherence to Treatment in People Living With HIV: A Systematic Review and Meta-analysis

Jianhua Hou  1   2 , Jiangning Fu  3 , Siyan Meng  4 , Taiyi Jiang  1   2 , Caiping Guo  1 , Hao Wu  1   2 , Bin Su  1   2 , Tong Zhang  1   2
Affiliations

Posttraumatic Stress Disorder and Nonadherence to Treatment in People Living With HIV: A Systematic Review and Meta-analysis

Jianhua Hou et al. Front Psychiatry. .

Abstract

Background: Posttraumatic stress disorder (PTSD) is a commonly reported and serious complication among people living with HIV (PLWH). PTSD may significantly increase unintentional non-adherence to antiretroviral therapy. In this systematic review and meta-analysis, we aimed to pool the observational studies exploring the association between PTSD and medication adherence among PLWH.

Methods: Comprehensive searches were conducted in PubMed/Medline, Web of Science, PsycINFO, Google Scholar, and ProQuest to identify relevant articles and dissertations. A random effects meta-analysis with inverse variance weighting was used to summarize the odds ratio (OR) across studies. Meta-regression and subgroup analyses were also carried out to assess the moderation effects for potential factors.

Results: By synthesizing 12 studies comprising 2489 participants, the pooled odd ratio of non-adherence to antiretroviral therapy was 1.19 (95% confidential interval (CI), 1.03-1.37, p = 0.02). No significant publication bias was detected by Egger's test (Intercept = 0.842, p = 0.284). Factors moderating the association were mean age of participants, depression adjustment, and depression (all p < 0.05).

Conclusions: This meta-analysis supports that PTSD is related to adherence in PLWH. The hypothesized mechanisms (avoidant behavior and cognitive impairment) underlying this association need further investigation. Overall, this study highlights that clinicians should thoughtfully integrate timely mental health intervention into routine care.

Keywords: antiretroviral therapy adherence; meta-analysis; people living with HIV; posttraumatic stress disorder; systematic review.

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Figures

Figure 1
Figure 1
The flowchart of included studies.
Figure 2
Figure 2
The forest plot for the association between PTSD and ART adherence for PLWH.
Figure 3
Figure 3
The funnel plot for the association between PTSD and ART adherence for PLWH.
See this image and copyright information in PMC

References

    1. Verhey R, Gibson L, Brakarsh J, Chibanda D, Seedat S. Prevalence and correlates of probable post-traumatic stress disorder and common mental disorders in a population with a high prevalence of HIV in Zimbabwe. Eur J Psychotraumatol (2018) 9:9. 10.1080/20008198.2018.1536286 - DOI - PMC - PubMed
    1. Luo ST, Lin CQ, Ji GP, Li L. Post-traumatic Stress Disorder Symptoms Among People Living with HIV/AIDS in Rural China. AIDS Behav (2017) 21:3202–8. 10.1007/s10461-016-1641-1 - DOI - PMC - PubMed
    1. Devieux JG, Malow RM, Attonito JM, Jean-Gilles M, Rosenberg R, Gaston S, et al. Post-traumatic stress disorder symptomatology and alcohol use among HIV-seropositive adults in Haiti. AIDS Care-Psychol Socio-Med Asp Aids-Hiv (2013) 25:1210–8. 10.1080/09540121.2013.763894 - DOI - PMC - PubMed
    1. Sherr L, Nagra N, Kulubya G, Catalan J, Clucas C, Harding R. HIV infection associated post-traumatic stress disorder and post-traumatic growth - A systematic review. Psychol Health Med (2011) 16:612–29. 10.1080/13548506.2011.579991 - DOI - PubMed
    1. Tang C, Goldsamt L, Meng J, Xiao X, Zhang L, Williams AB, et al. Global estimate of the prevalence of post-traumatic stress disorder among adults living with HIV: a systematic review and meta-analysis. BMJ Open (2020) 10:e032435. 10.1136/bmjopen-2019-032435 - DOI - PMC - PubMed

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