title: Effects of syndemics on HIV viral load and medication adherence in the multicentre AIDS cohort study.
abstract: OBJECTIVE
  The objective of this study is to determine associations between intertwining epidemics (syndemics) and HIV medication adherence and viral load levels among HIV-positive MSM and to test whether adherence mediates the relationship between syndemics and viral load.
  
  
  METHODS
  We analysed participant data collected between 2003 and 2009 from the Multicenter AIDS Cohort Study, a prospective HIV/AIDS cohort study in four U.S. cities.
  
  
  METHODS
  We conducted longitudinal analyses (repeated measures mixed models) to assess whether differences in viral load levels, undetectable viral load and self-reported HIV medication adherence were associated with count of syndemic conditions (substance use, depression symptoms and sexual risk behaviour, range 0-3), adjusting for race/ethnicity, age and income. Mediation analyses were conducted using structural equation modelling and the SAS %mediate macro.
  
  
  RESULTS
  Syndemics count was associated with higher viral loads (P < 0.0001) and lower adherence (P < 0.0001). Increased counts of concomitant syndemics were associated with viral load (P < 0.01), detectable viral load (P < 0.05) and adherence (P < 0.001). Black MSM experienced worse outcomes across domains than white MSM (P < 0.0001) and experienced higher overall rates of syndemics (P < 0.01). Adherence significantly mediated the relationship between syndemics and viral load, accounting for an estimated 32.3% of the effect (P < 0.05).
  
  
  CONCLUSIONS
  Effectively lowering viral load levels among MSM has implications for both HIV/AIDS prevention and care. Our findings suggest that integrating substance use interventions, mental healthcare and sexual risk prevention into standard HIV care may be necessary to optimize treatment and Treatment as Prevention (TasP) models.
authors: aDepartment of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh bCenter for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania cDepartment of Behavioral and Community Health Sciences, Graduate School of Public Health, University of California-San Francisco, San Francisco dDepartment of Epidemiology and Biostatistics, School of Medicine, University of California-San Francisco, San Francisco eDepartment of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California fDepartment of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland gDepartment of Medical Social Sciences, Northwestern University, Chicago, Illinois hDepartment of Medicine, Georgetown University Medical Center, Washington, DC, USA.
authors: M Reuel
authors: MR
authors: Friedman
authors: Ron
authors: R
authors: Stall
authors: Anthony J
authors: AJ
authors: Silvestre
authors: Chongyi
authors: C
authors: Wei
authors: Steve
authors: S
authors: Shoptaw
authors: Amy
authors: A
authors: Herrick
authors: Pamela J
authors: PJ
authors: Surkan
authors: Linda
authors: L
authors: Teplin
authors: Michael W
authors: MW
authors: Plankey
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000821:virology*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents