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From the Department of Psychology and Behavioral Medicine (G.I., C.O., J.P.L., E.B., N.S.), Department of Psychiatry (G.I., N.S.), Department of Medicine (M.A.F., N.K., N.S.), University of Miami, Coral Gables, Florida.
Address correspondence and reprint requests to Gail Ironson, MD, PhD, Department of Psychology and Behavioral Medicine, University of Miami, PO Box 248185, Coral Gables, FL 33124-2070. E-mail: gironson{at}aol.com
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.
Key Words: HIV/AIDS • disease progression • adherence • depression • coping • stress
Abbreviations: HAART = highly active antiretroviral treatment; VL = viral load; HIV = human immunodeficiency virus; AIDS = acquired immunodeficiency syndrome; PI = protease inhibitor; HLM = hierarchical linear modeling; DR = decline ratio; SES = socioeconomic status; BDI = Beck Depression Inventory; BHS = Beck Hopelessness Scale; N/A = not applicable.
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