The differential impact of PTSD and depression on HIV disease markers and adherence to HAART in people living with HIV.

Department of Psychology, Kent State University, Kent, Ohio 44240, USA.
AIDS and Behavior (Impact Factor: 3.49). 06/2006; 10(3):253-61. DOI: 10.1007/s10461-006-9069-7
Source: PubMed

ABSTRACT Despite high rates of comorbidity, research has typically focused on the independent impact of posttraumatic stress disorder (PTSD) and depression symptoms in people living with HIV (PLWH). The present study examined the independent and comorbid influence of PTSD and depression symptoms on medication adherence, CD4 cell counts, and viral load, over the course of 3 months in 57 PLWH (82% men, 54% Caucasian, 44% African American) recruited from a clinic or social service agency. Both PTSD and depressive symptoms predicted lower subsequent adherence. However, only depressive symptoms predicted lower CD4 counts and presence of a detectable viral load. Participants reporting symptoms consistent with diagnostic levels of comorbid PTSD and depression were less likely to adhere to HAART and were more likely to have a detectable viral load. These results highlight the influences of PTSD and depression on adherence and HIV disease markers, and underscore the importance of examining comorbid symptomatology in PLWH.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence.Methods We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression.ResultsIn total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD¿=¿0.603, P¿=¿0.001), current substance use (SMD¿=¿¿0.395, P¿=¿0.001), concerns about ART (SMD¿=¿¿0.388, P¿=¿0.001), beliefs about the necessity/utility of ART (SMD¿=¿0.357, P¿=¿0.001), trust/satisfaction with the HIV care provider (SMD¿=¿0.377, P¿=¿0.001), depressive symptoms (SMD¿=¿¿0.305, P¿=¿0.001), stigma about HIV (SMD¿=¿¿0.282, P¿=¿0.001), and social support (SMD¿=¿0.237, P¿=¿0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD¿=¿¿0.196, P¿=¿0.001), daily dosing frequency (SMD¿=¿¿0.193, P¿=¿0.001), financial constraints (SMD ¿0.187, P¿=¿0.001) and pill burden (SMD¿=¿¿0.124, P¿=¿0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries.Conclusions These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.
    BMC Medicine 08/2014; 12(1):142. DOI:10.1186/PREACCEPT-1453408941291432 · 7.28 Impact Factor
    This article is viewable in ResearchGate's enriched format
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is limited information on depression in Haitians and this is partly attributable to the absence of culturally and linguistically adapted measures for depression.
    Journal of General Internal Medicine 08/2014; DOI:10.1007/s11606-014-2951-5 · 3.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous studies demonstrate that PTSD mediates the relationship between childhood trauma and alcohol and substance use disorders and that PTSD and alcohol/substance use comorbidity is greater in men than in women. We sought to replicate and extend these findings in a predominantly low-income, African-American sample recruited from a public hospital. We administered measures of childhood trauma, PTSD symptoms, problematic alcohol use, and problematic substance use to 803 men and 2084 women. We examined rates of comorbidity in men and women. Next, two bootstrap analyses were used to test whether PTSD is a mediator between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use. Finally, two bootstrap analyses were used to test whether gender would moderate the indirect effect of PTSD in both the alcohol and substance use models. Results showed that although men and women reported similar overall PTSD symptom frequency, men were more likely than women to report PTSD comorbid with alcohol and/or substance use problems. In addition, PTSD partially mediated the relationship between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use. The indirect effects of PTSD on the relationship between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use were greater in men. This study demonstrates the important interplay of gender, childhood trauma, PTSD, and alcohol and substance use. Mental health providers should consider childhood trauma histories and diagnostic comorbidities when treatment planning.
    Child Abuse & Neglect 02/2015; DOI:10.1016/j.chiabu.2015.01.007 · 2.47 Impact Factor