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Affect Regulation, Stimulant Use, and Viral Load Among HIV-Positive Persons on Anti-Retroviral Therapy

From the Department of Psychiatry (A.W.C.), University of California, San Francisco, San Francisco, California; Center for AIDS Prevention Studies (M.O.J., T.B.N., S.F.M., E.D.C., W.T.S., NIMH Healthy Living Project Team), University of California, San Francisco, San Francisco, California; Osher Center for Integrative Medicine (J.T.M.), University of California, San Francisco, San Francisco, California; New York State Psychiatric Institute/Columbia University (R.H.R., NIMH Healthy Living Project Team), New York, New York; Center for Community Health (F.L.W., M.J.R.-B., M.A.L., NIMH Healthy Living Project Team), University of California, Los Angeles, Los Angeles, California; National Institutes of Health Center for Complementary and Alternative Medicine (M.A.C.); Medical College of Wisconsin (NIMH Healthy Living Project Team), Milwaukee, Wisconsin.

Address correspondence and reprint requests to Adam W. Carrico, University of California, San Francisco, Health Psychology Program, 3333 California St., Suite 465, Box 0848, San Francisco, CA 94143-0848. E-mail: adam.carrico{at}ucsf.edu

Objective: A substantial minority of HIV-positive individuals have comorbid affective or substance use disorders, which can interfere with effective medical management. The present study examined the associations among affect regulation, substance use, non-adherence to anti-retroviral therapy (ART), and immune status in a diverse sample of HIV-positive persons.

Methods: A total of 858 HIV-positive participants self-reporting risk of transmitting HIV were enrolled in a randomized behavioral prevention trial and provided baseline blood samples to measure T-helper (CD4+) counts and HIV viral load.

Results: Among individuals on ART, regular stimulant users had a five-fold (0.70 log₁₀) higher HIV viral load than those who denied regular stimulant use. The association between regular stimulant use and elevated HIV viral load remained after accounting for demographics, differences in CD4+ counts, and polysubstance use. In the final model, 1 unit increase in affect regulation (decreased severity of depressive symptoms as well as enhanced positive states of mind) was associated with a 23% decrease in the likelihood of reporting regular stimulant use and 15% decrease in the likelihood of being classified as nonadherent to ART. Regular stimulant users, in turn, were more than twice as likely to be nonadherent to ART. Even after accounting for the effects of nonadherence and CD4+ counts, regular stimulant use was independently associated with 50% higher HIV viral load.

Conclusions: Increased mental health treatment as well as more intensive referrals to substance abuse treatment or 12-step self-help groups may be crucial to assist stimulant users with more effectively managing treatment for HIV/AIDS.

Key Words: adherence • affect • cocaine • depression • methamphetamine • HIV

Abbreviations: ACASI = audio-computer-assisted self-interviewing; AIDS = acquired immune deficiency syndrome; ART = anti-retroviral therapy; BDI = Beck Depression Inventory I; CFI = comparative fit index; HIV = human immunodeficiency virus; PSOM = positive states of mind; RMSEA = root mean square error of approximation; CD4+ = T-helper; WRMR = weighted root mean square residual.