title: Stressful and traumatic life events as disruptors to antiretroviral therapy adherence.
abstract: Stressful and traumatic life events (STLEs) are common among HIV-infected individuals and may affect health behaviors such as adherence to antiretroviral (ARV) therapy, with important implications for treatment outcomes. We examined the association between STLEs and ARV adherence among 289 US-based participants enrolled between 7/1/2010 and 9/1/2013 in a study of depression treatment for HIV-infected patients. Participants received monthly telephone calls to assess STLEs and pill count-based ARV adherence. Inverse probability of observation weighting was combined with multiple imputation to address missing data. Participants were mostly male (71%) and black (63%), with a median age of 45 years. Median monthly adherence was 96% (interquartile range (IQR): 85-100%). Participants experienced a mean of 2.48 STLEs (range: 0-14) in the previous month. The presence of ≥2 STLEs was associated with a mean change in adherence of -3.67% (95% confidence interval (CI): -7.12%, -0.21%) and decreased likelihood of achieving ≥95% adherence (risk ratio (95% CI) = 0.82 (0.71, 0.95)). For each additional STLE, the mean adherence change was -0.90% (95% CI: -1.79%, 0.00%). STLEs were associated with poorer ARV adherence, including decreased likelihood of adhering to ≥95% of ARV doses. This level of adherence has a critical role in regimen effectiveness and prevention of resistance.
authors.affiliation: a Department of Epidemiology , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , USA.
authors.forename: Julie K
authors.initials: JK
authors.lastname: O'Donnell
authors.affiliation: b Department of Psychiatry , University of North Carolina, School of Medicine , Chapel Hill , USA.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
authors.affiliation: a Department of Epidemiology , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.affiliation: a Department of Epidemiology , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Edmonds
authors.affiliation: c Center for Health Policy , Duke Global Health Institute, Duke University , Durham , USA.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
authors.affiliation: d Institute for Global Health and Infectious Diseases , Center for AIDS Research, University of North Carolina , Chapel Hill , USA.
authors.forename: E Byrd
authors.initials: EB
authors.lastname: Quinlivan
authors.affiliation: e Institute for Global Health and Infectious Diseases , University of North Carolina , Chapel Hill , USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Heine
authors.affiliation: f Division of Infectious Diseases , University of Alabama, Birmingham School of Medicine , Birmingham , USA.
authors.forename: Rhiddi
authors.initials: R
authors.lastname: Modi
authors.affiliation: a Department of Epidemiology , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008016:Life Change Events; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D016017:Odds Ratio; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral; HIV; medication adherence; mental health; stressful events