title: Trauma, dissociation, and antiretroviral adherence among persons living with HIV/AIDS.
abstract: BACKGROUND
  There are approximately 1,000,000 persons living with HIV/AIDS (PLH) in the United States; to reduce rates of new infection and curb disease progression, adherence to HIV medication among PLH is critical. Despite elevated trauma rates in PLH, no studies to date have investigated the relationship between dissociation, a specific symptom of trauma, and HIV medication adherence. We hypothesized that Post-Traumatic Stress Disorder (PTSD) symptoms would be associated with lower adherence, and that dissociation would moderate this relationship.
  
  
  METHODS
  Forty-three individuals with HIV were recruited from community-based clinics to participate in a cross-sectional study. The relationship of trauma, dissociation, and their interaction to the probability of antiretroviral adherence was assessed using a hierarchical binary logistic regression analysis.
  
  
  RESULTS
  Among 38 eligible participants, greater PTSD was associated with lower odds of adherence (OR = .92, p < .05). Dissociation moderated the effect of PTSD on adherence, resulting in lower odds of adherence (OR = .95, p < .05). PTSD symptoms were significantly associated with lower odds of adherence in individuals reporting high levels of dissociation (OR = .86, p < .05) but not in those reporting low levels of dissociation (OR = 1.02, p > .05).
  
  
  CONCLUSIONS
  This is the first study to demonstrate a relationship between dissociation and medication adherence. Findings are discussed in the context of clinical management of PLH with trauma histories and the need for interventions targeting dissociative symptomatology to optimize adherence.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA. akeuroghlian@partners.org
authors.forename: Alex S
authors.initials: AS
authors.lastname: Keuroghlian
authors.forename: Charles S
authors.initials: CS
authors.lastname: Kamen
authors.forename: Eric
authors.initials: E
authors.lastname: Neri
authors.forename: Susanne
authors.initials: S
authors.lastname: Lee
authors.forename: Rhianon
authors.initials: R
authors.lastname: Liu
authors.forename: Cheryl
authors.initials: C
authors.lastname: Gore-Felton
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000523:psychology*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004213:Dissociative Disorders / Q000175:diagnosis / Q000523:psychology*; D004334:Drug Administration Schedule; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008016:Life Change Events; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology*
chemical_list: D019380:Anti-HIV Agents