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.
RCT Entities:
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.
Authors: Gregory M Lucas; Michael Griswold; Kelly A Gebo; Jeanne Keruly; Richard E Chaisson; Richard D Moore Journal: Am J Epidemiol Date: 2006-01-04 Impact factor: 4.897
Authors: Kathryn Anastos; Michael F Schneider; Stephen J Gange; Howard Minkoff; Ruth M Greenblatt; Joseph Feldman; Alexandra Levine; Robert Delapenha; Mardge Cohen Journal: J Acquir Immune Defic Syndr Date: 2005-08-15 Impact factor: 3.731
Authors: Xiuhong Li; Joseph B Margolick; Craig S Conover; Sheila Badri; Sharon A Riddler; Mallory D Witt; Lisa P Jacobson Journal: J Acquir Immune Defic Syndr Date: 2005-03-01 Impact factor: 3.731
Authors: Michael H Antoni; Adam W Carrico; Ron E Durán; Susan Spitzer; Frank Penedo; Gail Ironson; Mary Ann Fletcher; Nancy Klimas; Neil Schneiderman Journal: Psychosom Med Date: 2006 Jan-Feb Impact factor: 4.312
Authors: Judith A Cook; Mardge H Cohen; Jane Burke; Dennis Grey; Kathryn Anastos; Lynn Kirstein; Herminia Palacio; Jean Richardson; Tracey Wilson; Mary Young Journal: J Acquir Immune Defic Syndr Date: 2002-08-01 Impact factor: 3.731
Authors: Alexander C Tsai; Dan H Karasic; Gwendolyn P Hammer; Edwin D Charlebois; Kathy Ragland; Andrew R Moss; James L Sorensen; James W Dilley; David R Bangsberg Journal: Am J Public Health Date: 2012-06-21 Impact factor: 9.308
Authors: Jane M Simoni; David Huh; Ira B Wilson; Jie Shen; Kathy Goggin; Nancy R Reynolds; Robert H Remien; Marc I Rosen; David R Bangsberg; Honghu Liu Journal: J Acquir Immune Defic Syndr Date: 2012-08-15 Impact factor: 3.731
Authors: Loveleen Bansi-Matharu; Gabriela Rodriguez Loria; Stephen R Cole; Henry Mugerwa; Isabel Vecino; Jens Lundgren; Piotr Pulik; Colette Smith; Andrew N Phillips Journal: AIDS Date: 2019-07-01 Impact factor: 4.177
Authors: Sarah Ickowicz; Evan Wood; Huiru Dong; Paul Nguyen; Will Small; Thomas Kerr; Julio S G Montaner; M-J Milloy Journal: Drug Alcohol Depend Date: 2017-08-10 Impact factor: 4.492
Authors: Adam W Carrico; Peter W Hunt; Torsten B Neilands; Samantha E Dilworth; Jeffrey N Martin; Steven G Deeks; Elise D Riley Journal: J Acquir Immune Defic Syndr Date: 2019-01-01 Impact factor: 3.731