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Psychiatric Risk Factors for HIV Disease Progression: The Role of Inconsistent Patterns of Antiretroviral Therapy Utilization

Carrico, Adam W PhD*; Riley, Elise D PhD, MPH*†; Johnson, Mallory O PhD*; Charlebois, Edwin D PhD, MPH*; Neilands, Torsten B PhD*; Remien, Robert H PhD; Lightfoot, Marguerita A PhD*; Steward, Wayne T PhD, MPH*; Weinhardt, Lance S PhD§; Kelly, Jeffrey A PhD§; Rotheram-Borus, Mary Jane PhD; Morin, Stephen F PhD*; Chesney, Margaret A PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1st, 2011 - Volume 56 - Issue 2 - p 146-150
doi: 10.1097/QAI.0b013e318201df63
Clinical Science

Background: In the era of antiretroviral 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.

Methods: Using outcome data from 603 participants enrolled in a randomized controlled trial of a behavioral intervention, binary logistic and linear regression were employed to examine whether inconsistent patterns of ART utilization partially mediated the effects of depression and substance use on higher HIV viral load over a 25-month follow-up.

Results: Elevated affective symptoms of depression independently predicted ART discontinuation [adjusted odds ratio = 1.39, 95% confidence interval (CI) = 1.08 to 1.78], and use of stimulants at least weekly independently predicted intermittent ART utilization (adjusted odds ratio = 2.62, 95% CI = 1.45 to 4.73). After controlling for the average self-reported percentage of ART doses taken and baseline T-helper (CD4+) count, elevated depressive symptoms predicted a 50% higher mean viral load, and weekly stimulant use predicted a 137% higher mean viral load. These effects became nonsignificant after accounting for inconsistent patterns of ART utilization, providing evidence of partial mediation.

Conclusions: Inconsistent patterns of ART utilization may partially explain the effects of depression and stimulant use on hastened HIV disease progression.

From the *Center for AIDS Prevention Studies, University of California, San Francisco, CA; †Epidemiology and Prevention Interventions Center, San Francisco General Hospital, San Francisco, CA; ‡New York State Psychiatric Institute/Columbia University, New York, NY; §Milwaukee Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI; ∥University of California, Los Angeles, Los Angeles, CA; and ¶Osher Center for Integrative Medicine, University of California, San Francisco, CA.

Received for publication March 8, 2010; accepted October 6, 2010.

This research was funded by National Institute of Mental Health grants U10-MH57636, U10-MH57631, U10-MH57616, and U10-MH57615; and National Institute of Mental Health center grants P30-MH058107 (M.J.R.B., PhD, PI), P30-MH57226 (J.A.K., PhD, PI), P30-MH43520 (A.A.E., PhD, PI), and P30-MH062246 (T.J.C., PhD, PI).

The authors declare no conflicts of interest related to the study.

Correspondence to: Adam W. Carrico, PhD, Center for AIDS Prevention Studies, University of California, San Francisco, 50 Beale Street, Suite 1300, San Francisco, CA 94105 (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.