title: Intimate partner violence: a predictor of worse HIV outcomes and engagement in care.
abstract: For HIV-infected patients, experiencing multiple traumas is associated with AIDS-related and all-cause mortality, increased opportunistic infections, progression to AIDS, and decreased adherence to therapy. The impact of intimate partner violence (IPV) on adherence and HIV outcomes is unknown. HIV-infected patients recruited from a public HIV clinic participated in this observational cohort study (n=251). Participants completed interviews evaluating IPV and covariates. CD4 count <200 (CD4<200), detectable HIV viral load (VL), and engagement in care ("no show rate" [NSR]) were the outcomes of interest. Medication adherence was not measured. Univariate and multivariate regression analyses were performed with covariates included if p<0.3 in the univariate phase. Seventy-four percent of the participants were male, 55% Caucasian, and 52.2% self-identified as "men who have sex with men." IPV prevalence was 33.1% with no difference by gender or sexual orientation. In univariate analysis, IPV exposure predicted having a CD4<200 (p=0.005) and a detectable VL (p=0.04) but trended toward significance with a high NSR (p=0.077). Being threatened by a partner was associated with a CD4<200 (p=0.005), a detectable VL (p=0.011), and high NSR (p=0.019) in univariate analysis. In multivariate analysis, IPV predicted having a CD4<200 (p=0.005) and detectable VL (p=0.035). Being threatened by a partner predicted having a CD4<200 (p=0.020), a detectable VL (p=0.007), and a high NSR (p=0.020). Our results suggest IPV impacts biologic outcomes and engagement in care for HIV-infected patients. IPV alone predicts worse biologic outcomes, whereas the specific experience of being threatened by a partner was associated with all three outcomes in univariate and multivariate analyses.
authors.affiliation: Department of Medicine, Division of Infectious Diseases and International Health University of Virginia Charlottesville, USA. ks2vd@virginia.edu
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Schafer
authors.forename: Julia
authors.initials: J
authors.lastname: Brant
authors.forename: Shruti
authors.initials: S
authors.lastname: Gupta
authors.forename: John
authors.initials: J
authors.lastname: Thorpe
authors.forename: Christopher
authors.initials: C
authors.lastname: Winstead-Derlega
authors.forename: Relana
authors.initials: R
authors.lastname: Pinkerton
authors.forename: Kathryn
authors.initials: K
authors.lastname: Laughon
authors.forename: Karen
authors.initials: K
authors.lastname: Ingersoll
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dillingham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018791:CD4 Lymphocyte Count; D017579:Domestic Violence; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000523:psychology* / Q000628:therapy* / Q000821:virology; D015438:Health Behavior; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011379:Prognosis; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult