Overload: impact of incident stressful events on antiretroviral medication adherence and virologic failure in a longitudinal, multisite human immunodeficiency virus cohort study.

Journal Article (Clinical Trial;Journal Article;Multicenter Study)

OBJECTIVE: To examine the influence of incident stressful experiences on antiretroviral medication adherence and treatment outcomes. Past trauma history predicts poorer medication adherence and health outcomes. Human immunodeficiency virus (HIV)-infected individuals experience frequently traumatic and stressful events, such as sexual and physical assault, housing instability, and major financial, employment, and legal difficulties. METHODS: We measured prospectively incident stressful and traumatic events, medication adherence, and viral load over 27 months in an eight-site, five-state study. Using multivariable logistic and generalized estimating equation modeling, we assessed the impact of incident stressful events on 27-month changes in self-reported medication adherence and virologic failure (viral load = >or=400 c/mL). RESULTS: Of 474 participants on antiretroviral therapy at baseline, 289 persons were interviewed and still received treatment at 27 months. Participants experiencing the median number of incident stressful events (n = 9) had over twice the predicted odds (odds ratio = 2.32) of antiretroviral medication nonadherence at follow-up compared with those with no events. Stressful events also predicted increased odds of virologic failure during follow-up (odds ratio = 1.09 per event). CONCLUSIONS: Incident stressful events are exceedingly common in the lives of HIV-infected individuals and negatively affect antiretroviral medication adherence and treatment outcomes. Interventions to address stress and trauma are needed to improve HIV outcomes.

Full Text

Duke Authors

Cited Authors

  • Mugavero, MJ; Raper, JL; Reif, S; Whetten, K; Leserman, J; Thielman, NM; Pence, BW

Published Date

  • November 2009

Published In

Volume / Issue

  • 71 / 9

Start / End Page

  • 920 - 926

PubMed ID

  • 19875634

Pubmed Central ID

  • PMC3691857

Electronic International Standard Serial Number (EISSN)

  • 1534-7796

Digital Object Identifier (DOI)

  • 10.1097/PSY.0b013e3181bfe8d2


  • eng

Conference Location

  • United States