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Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy.

Publication ,  Journal Article
Pence, BW; Miller, WC; Gaynes, BN; Eron, JJ
Published in: J Acquir Immune Defic Syndr
February 1, 2007

BACKGROUND: Mental illness (MI) and substance abuse (SA) are common in HIV-positive patients. MI/SA consistently predict poorer antiretroviral adherence, suggesting that affected patients should be at higher risk of poor virologic and immunologic response to highly active antiretroviral therapy (HAART). PARTICIPANTS: 198 HAART-naive patients initiated HAART at an academic medical center serving a heterogeneous population. METHODS: Participants were assigned a predicted probability from 0 to 1 of having each of the following: (1) any mood, anxiety, or substance use disorder; (2) clinically relevant depression; (3) alcohol abuse/dependence; and (4) drug abuse/dependence. Probabilities were based on responses to questions on an MI/SA screening instrument (Substance Abuse and Mental Illness Symptoms Screener [SAMISS]) and other clinical and sociodemographic characteristics and were derived using predictive logistic regression modeling from a separate validation study of the SAMISS compared with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses. Using survival analysis techniques, we assessed baseline predicted probability of psychiatric illness as a predictor of time from HAART initiation to virologic suppression (first viral load [VL] <400 copies/mL), from HAART initiation to overall virologic failure (first VL >or=400 copies/mL after suppression, time set to 0 for patients never achieving suppression), from virologic suppression to virologic rebound (first VL >or=400 copies/mL), and from HAART initiation to immunologic failure (first CD4 cell count lower than baseline). RESULTS: A higher predicted probability of any psychiatric disorder was associated with a slower rate of virologic suppression (adjusted hazard ratio [aHR] = 0.86 per 25% increment, 95% confidence interval [CI]: 0.75 to 0.98) and a faster rate of overall virologic failure (aHR = 1.22, 95% CI: 1.06 to 1.40). Associations with other outcomes were consistent in direction but not statistically significant. Predicted probability of depression was associated with slower virologic suppression (aHR = 0.79, 95% CI: 0.63 to 0.98), and predicted probabilities of alcohol and drug abuse/dependence was associated with faster overall virologic failure (aHR = 1.37, 95% CI: 1.08 to 1.74 and aHR = 1.18, 95% CI: 1.00 to 1.39, respectively). CONCLUSIONS: These results are consistent with an inferior virologic response to first HAART among patients with concurrent mood, anxiety, and substance use disorders, suggesting a clinical benefit to identification and treatment of psychiatric illness among patients initiating antiretroviral therapy.

Duke Scholars

Published In

J Acquir Immune Defic Syndr

DOI

ISSN

1525-4135

Publication Date

February 1, 2007

Volume

44

Issue

2

Start / End Page

159 / 166

Location

United States

Related Subject Headings

  • Virology
  • Viral Load
  • Treatment Outcome
  • Substance-Related Disorders
  • Statistics as Topic
  • Mood Disorders
  • Middle Aged
  • Mental Disorders
  • Male
  • Logistic Models
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pence, B. W., Miller, W. C., Gaynes, B. N., & Eron, J. J. (2007). Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr, 44(2), 159–166. https://doi.org/10.1097/QAI.0b013e31802c2f51
Pence, Brian Wells, William C. Miller, Bradley N. Gaynes, and Joseph J. Eron. “Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy.J Acquir Immune Defic Syndr 44, no. 2 (February 1, 2007): 159–66. https://doi.org/10.1097/QAI.0b013e31802c2f51.
Pence BW, Miller WC, Gaynes BN, Eron JJ. Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2007 Feb 1;44(2):159–66.
Pence, Brian Wells, et al. “Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy.J Acquir Immune Defic Syndr, vol. 44, no. 2, Feb. 2007, pp. 159–66. Pubmed, doi:10.1097/QAI.0b013e31802c2f51.
Pence BW, Miller WC, Gaynes BN, Eron JJ. Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2007 Feb 1;44(2):159–166.

Published In

J Acquir Immune Defic Syndr

DOI

ISSN

1525-4135

Publication Date

February 1, 2007

Volume

44

Issue

2

Start / End Page

159 / 166

Location

United States

Related Subject Headings

  • Virology
  • Viral Load
  • Treatment Outcome
  • Substance-Related Disorders
  • Statistics as Topic
  • Mood Disorders
  • Middle Aged
  • Mental Disorders
  • Male
  • Logistic Models