title: Affect regulation, stimulant use, and viral load among HIV-positive persons on anti-retroviral therapy.
abstract: 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.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, CA 94143-0848, USA. adam.carrico@ucsf.edu
authors.forename: Adam W
authors.initials: AW
authors.lastname: Carrico
authors.forename: Mallory O
authors.initials: MO
authors.lastname: Johnson
authors.forename: Judith T
authors.initials: JT
authors.lastname: Moskowitz
authors.forename: Torsten B
authors.initials: TB
authors.lastname: Neilands
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Morin
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
authors.forename: Wayne T
authors.initials: WT
authors.lastname: Steward
authors.forename: Robert H
authors.initials: RH
authors.lastname: Remien
authors.forename: F Lennie
authors.initials: FL
authors.lastname: Wong
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Rotheram-Borus
authors.forename: Marguerita A
authors.initials: MA
authors.lastname: Lightfoot
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Chesney
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D000697:Central Nervous System Stimulants / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000523:psychology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D000697:Central Nervous System Stimulants