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

Published

Journal Article

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.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).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).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

  • 19875634

Electronic International Standard Serial Number (EISSN)

  • 1534-7796

International Standard Serial Number (ISSN)

  • 0033-3174

Digital Object Identifier (DOI)

  • 10.1097/PSY.0b013e3181bfe8d2

Language

  • eng