title: Overload: impact of incident stressful events on antiretroviral medication adherence and virologic failure in a longitudinal, multisite human immunodeficiency virus cohort study.
abstract: 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 = >or=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.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-2050, USA. mmugavero@uab.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: James L
authors.initials: JL
authors.lastname: Raper
authors.forename: Susan
authors.initials: S
authors.lastname: Reif
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whetten
authors.forename: Jane
authors.initials: J
authors.lastname: Leserman
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
authors.forename: Brian Wells
authors.initials: BW
authors.lastname: Pence
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015144:Southeastern United States / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects