Psychosocial Factors Predict CD4 and Viral Load Change in Men and Women With Human Immunodeficiency Virus in the Era of Highly Active Antiretroviral Treatment

Abstract

Objective-Most previous longitudinal studies demonstrating relationships between psychosocial variables and human immunodeficiency virus (HIV) disease progression utilized samples of gay men accrued before the era of highly active antiretroviral treatment (HAART), without including viral load (VL) as an indicator of disease progression or assessing the impact of medication adherence. This study sought to determine whether psychosocial variables would predict both CD4 and VL changes in a diverse sample assessed entirely during the era of HAART and accounting for adherence effects.Methods-This longitudinal study assessed a multiethnic HIV+ sample (n = 177) of men and women in the midrange of illness (CD4 number between 150 and 500; no previous acquired immunodeficiency syndrome [AIDS]-defining symptom) every 6 months for 2 years. Hierarchical linear modeling was used to model change in CD4 and VL controlling for sociodemographics (age, gender, ethnicity, education) and medical variables (baseline CD4/VL, antiretroviral medications at each time point, adherence).Results-Baseline depression, hopelessness, and education predicted the slope of CD4 and VL. Avoidant coping and life event stress predicted VL change. Cumulative variables produced stronger relationships (depression, avoidant coping, and hopelessness with CD4/VL slope and life events stress with VL slope). High cumulative depression and avoidant coping were associated with approximately twice the rate of decline in CD4 as low scorers and greater relative increases in VL. Social support was not significantly related to CD4 or VL slope.Conclusions-Psychosocial factors contribute significantly to the variance in HIV disease progression (assessed through CD4 number and VL) in a diverse sample, accounting for adherence and do so in the era of HAART.

Two-year prospective study of major depressive disorder in HIV-infected men

“…On the other hand our finding a higher risk of major depression in patients with symptomatic disease short of AIDS is consistent with evidence of increase in depressive symptoms as disease progresses (Lyketsos et al, 1996). The finding that incident major depressive episode was associated with more rapid decline in immune function (CD4+ lymphocyte count) is consistent with evidence that depressive symptoms are associated with more rapid progression of HIV disease (Ironson et al, 2005).…”

“…Additionally reliance on cross-sectional designs may be inherently unreliable, since risk of major depression may vary over the course of HIV infection, and may increase with onset of frank AIDS (Lyketsos et al, 1996). Finally, an extensive literature relates increased depression symptoms to stressful life events and diminished social support within the context of HIV infection (Evans et al, 1997;, Ironson et al, 2005, but whether this bears on risk of major depressive episodes is not known. Although past psychiatric history, HIV systemic and CNS disease, and life adversity are thought to be intertwined, they customarily have been studied separately rather than together.…”

Heterogeneous response to HAART across a diverse population of people living with HIV: results from the ANRS-EN12-VESPA Study

“…Moreover, over half (53%) of the heterosexual migrants reported financial difficulties and 33% reported food privation through lack of money in the preceding month, compared to 21% and 7% of the other participants, respectively; social isolation, as defined by <1 weekly contact with family members/friends, concerned 20% of the heterosexual migrants versus 12% of the others (data available on request). Such adverse living conditions may have indirect effects on response to treatment through various pathways including poor adherence, high comorbidity (e.g., depression, tuberculosis, bacterial coinfections), inadequate healthcare, low social support, life event stress, or maladaptive coping [21,[28][29][30][31]. The low level of literacy of HIV-infected migrants [18] may further constitute a barrier to adequate access to care and HIV treatment adherence and knowledge, with consequences on health status [32,33].…”

Cognitive–Behavioral Stress Management Interventions for Persons Living with HIV: A Review and Critique of the Literature

“…Adjustment difficulties may also contribute to poor disease management [7,13]. Indeed, prior investigations have shown that heightened psychological distress is associated with accelerated disease progression as indicated by CD4 decline, increased viral load [13], and fewer natural killer cells [14].…”