Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment
Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment
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DOI：
10.1097/01.psy.0000188569.58998.c8
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发表时间：
2005-11-01
影响因子：
3.3
通讯作者：
Solomon, G
中科院分区：
文献类型：
--
作者：
Ironson, G;O'Cleirigh, C;Solomon, G
目的：以前的大多数纵向研究表明心理社会变量与人类免疫缺陷病毒(HIV)疾病进展之间的关系，使用的是在高效抗逆转录病毒治疗(HAART)时代之前积累的男同性恋者样本，没有将病毒载量(VL)作为疾病进展的指标或评估服药依从性的影响。这项研究试图确定心理社会变量是否能够预测在HAART时代完全评估并考虑坚持效应的不同样本中CD4和VL的变化。方法：这项纵向研究每6个月评估一次多民族HIV+样本(n=177)，其中男性和女性的病情处于中等水平(CD4值在150到500之间；以前没有获得性免疫缺陷综合征[AIDS]的定义症状)，为期两年。分层线性模型被用来模拟控制社会人口学(年龄、性别、种族、教育)和医学变量(基线CD4/VL、每个时间点的抗逆转录病毒药物、依从性)的CD4和VL的变化。结果：基线抑郁、绝望和受教育程度预测了CD4和VL的斜率。回避性应对和生活事件应激对VL改变有预测作用。累积变量(抑郁、回避性应对、绝望与CD4/VL斜率、生活事件应激与VL斜率)有较强的相关性。高累积抑郁和回避性应对与低得分者的CD4下降率和VL的相对增加有关，约为低得分者的两倍。社会支持与CD_4、V_L斜率无显著相关。结论：在不同的样本中，心理社会因素对HIV疾病进展的差异(通过CD4数和VL进行评估)有显著贡献，这是坚持的原因，在HAART时代也是如此。
Objective: Most previous longitudinal studies demonstrating relationships between psychosocial variables and human immunodeficiency virus (HIV) disease progression utilized samples of gay men accrued before the era of highly active antiretroviral treatment (HAART), without including viral load (VL) as an indicator of disease progression or assessing the impact of medication adherence. This study sought to determine whether psychosocial variables would predict both CD4 and VL changes in a diverse sample assessed entirely during the era of HAART and accounting for adherence effects. Methods: This longitudinal study assessed a multiethnic HIV+ sample (n = 177) of men and women in the midrange of illness (CD4 number between 150 and 500; no previous acquired immunodeficiency syndrome [AIDS]-defining symptom) every 6 months for 2 years. Hierarchical linear modeling was used to model change in CD4 and VL controlling for sociodemographics (age, gender, ethnicity, education) and medical variables (baseline CD4/VL, antiretroviral medications at each time point, adherence). Results: Baseline depression, hopelessness, and education predicted the slope of CD4 and VL. Avoidant coping and life event stress predicted VL change. Cumulative variables produced stronger relationships (depression, avoidant coping, and hopelessness with CD4/VL slope and life events stress with VL slope). High cumulative depression and avoidant coping were associated with approximately twice the rate of decline in CD4 as low scorers and greater relative increases in VL. Social support was not significantly related to CD4 or VL slope. Conclusions: Psychosocial factors contribute significantly to the variance in HIV disease progression (assessed through CD4 number and VL) in a diverse sample, accounting for adherence and do so in the era of HAART.