Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of anti-retroviral therapy utilization
A. Carrico1, E. Riley1, M. Johnson1, E. Charlebois1, T. Neilands1, R. Remien2, M. Lightfoot1, W. Steward1, L. Weinhardt3, J. Kelly3, M.J. Rotheram-Borus4, S. Morin1, M. Chesney1
1University of California San Francisco, San Francisco, United States, 2Columbia University, New York, United States, 3Medical College of Wisconsin, Milwaukee, United States, 4University of California at Los Angeles, Los Angeles, United States
Background: In the era of anti-retroviral 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. We examined whether inconsistent patterns of ART utilization explain the effects of depression and substance use on higher HIV viral load.
Methods: The Healthy Living Project is a randomized controlled trial of a behavioral intervention with a 25-month follow-up period. In total, 936 participants reporting HIV transmission risk behavior or sexual risk taking with a non-primary HIV-positive partner were enrolled. Outcome measures for the present study included: ART discontinuation (stopping ART and remaining off), intermittent ART utilization (stopping and restarting ART at least once), and mean HIV viral load over the 25-month follow-up.
Results: In 603 participants that completed at least three assessments, elevated affective symptoms of depression independently predicted a 39% increase in the odds of ART discontinuation (Adjusted OR [AOR] = 1.39, 95% CI = 1.08 - 1.78). Use of stimulants at least weekly independently predicted more than a 2.5-fold increase in the odds of intermittent ART utilization (AOR = 2.62, 95% CI = 1.45 - 4.73). There were no intervention effects on ART utilization (p > .20). After controlling for average self-reported percent of ART doses taken and baseline T-helper (CD4+) count, elevated depressive symptoms predicted a 50% higher mean viral load (p < .01) and weekly stimulant use predicted a 137% higher mean viral load (p < .05). These effects became non-significant after accounting for inconsistent patterns of ART utilization, providing evidence of mediation.
Conclusions: Inconsistent patterns of ART utilization may explain the effects of depression and stimulant use on hastened HIV disease progression. Adjuvant mental health and substance abuse treatment could boost the effectiveness of test and treat approaches to HIV prevention.
Back to the Programme-at-a-Glance