title: Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment.
abstract: 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.
authors.affiliation: Department of Psychology and Behavioral Medicine, University of Miami, Coral Gables, Florida 33124-2070, USA. gironson@aol.com
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Fletcher
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Laurenceau
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Balbin
authors.forename: Nancy
authors.initials: N
authors.lastname: Klimas
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
authors.forename: George
authors.initials: G
authors.lastname: Solomon
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D008016:Life Change Events; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance; D010555:Personality Inventory; D011379:Prognosis; D012737:Sex Factors; D012923:Social Class; D012944:Social Support; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents