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Published online before print October 29, 2009, 10.1097/PSY.0b013e3181bfe8d2
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Psychosomatic Medicine 71:920-926 (2009)
© 2009 American Psychosomatic Society

ORIGINAL ARTICLES

Overload: Impact of Incident Stressful Events on Antiretroviral Medication Adherence and Virologic Failure in a Longitudinal, Multisite Human Immunodeficiency Virus Cohort Study

Michael J. Mugavero, MD, MHSc, James L. Raper, DSN, CRNP, JD, FAANP, Susan Reif, PhD, MSW, Kathryn Whetten, PhD, MPH, Jane Leserman, PhD, Nathan M. Thielman, MD, MPH and Brian Wells Pence, PhD, MPH

From the Division of Infectious Diseases (M.J.M., J.L.R.), Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Center for Health Policy (S.R., K.W., B.W.P.), Department of Community and Family Medicine and Global Health Institute (K.W., B.W.P.), and the Division of Infectious Diseases and International Health (N.M.T.), Department of Medicine, Duke University, Durham, North Carolina; and the Department of Psychiatry (J.L.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Objective: To examine the influence of incident stressful experiences on antiretroviral medication adherence and treatment outcomes. Past trauma history predicts poorer medication adherence and health outcomes. Human immunodeficiency virus (HIV)-infected individuals experience frequently traumatic and stressful events, such as sexual and physical assault, housing instability, and major financial, employment, and legal difficulties.

Methods: We measured prospectively incident stressful and traumatic events, medication adherence, and viral load over 27 months in an eight-site, five-state study. Using multivariable logistic and generalized estimating equation modeling, we assessed the impact of incident stressful events on 27-month changes in self-reported medication adherence and virologic failure (viral load = ≥400 c/mL).

Results: Of 474 participants on antiretroviral therapy at baseline, 289 persons were interviewed and still received treatment at 27 months. Participants experiencing the median number of incident stressful events (n = 9) had over twice the predicted odds (odds ratio = 2.32) of antiretroviral medication nonadherence at follow-up compared with those with no events. Stressful events also predicted increased odds of virologic failure during follow-up (odds ratio = 1.09 per event).

Conclusions: Incident stressful events are exceedingly common in the lives of HIV-infected individuals and negatively affect antiretroviral medication adherence and treatment outcomes. Interventions to address stress and trauma are needed to improve HIV outcomes.

Key Words: HIV • AIDS • stress • adherence • virologic failure • disparities

Abbreviations: ARV = antiretroviral therapy; ASI = Addiction Severity Index; BSI = Brief Symptoms Inventory; CHASE = coping with HIV/AIDS in the Southeast; CI = Confidence Interval; OR = odds ratio; PLWHA = people living with HIV/AIDS; VL = viral load.






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