Effects of syndemics on HIV viral load and medication adherence in the multicentre Aids cohort study

Bibliographic Data

ID23344995
AuthorsM Reuel Friedman (0000-0001-6191-9799, Johns Hopkins University, corresponding author), Ron Stall (0000-0002-4741-4396, University of Pittsburgh), Anthony J Silvestre (University of Pittsburgh), Chongyi Wei (0000-0002-4424-5523, University of California, San Francisco), Steven Shoptaw (0000-0002-3583-0026, University of California, Los Angeles), Steve Shoptaw, Amy Herrick (University of Pittsburgh), Pamela J Surkan (0000-0002-0334-5931, Johns Hopkins University), Linda A Teplin (0000-0002-9807-6788, Northwestern University), Linda Teplin, Michael W Plankey, Michael Plankey (0000-0003-4554-7483, Georgetown University)
Year2015
Volume29
Issue9
Pages1087-1096
Publication date2015-06-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAIDS (JOURNAL)
Journal identifiersISSN: 0269-9370 • E-ISSN: 1473-5571
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/qad.0000000000000657
PMID25870981
OpenAlexW1971787534
LanguageEN
Citations received64
References cited42

OBJECTIVES: 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. DESIGN: 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). CONCLUSION: 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.

Antiretroviral therapy · Cohort · Cohort study · Human immunodeficiency virus (HIV) · Men who have sex with men · Multicenter AIDS Cohort Study · Prospective cohort study · Psychiatry · Psychological intervention · Syndemic · Syphilis · Viral load · Young adult · Demography · HIV-related health complications and treatments · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Immunology · Internal Medicine · Medicine

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