Predicting the Antiretroviral Medication Adherence and CD4 Measure in Patients with HIV/AIDS Based on the Post Traumatic Stress Disorder and Depression
,
Abstract
Background: Antiretroviral therapy has significantly reduced the prevalence of diseases and mortality rate caused by HIV; therefore, recognition of the factors affecting the antiretroviral therapy is of great importance. We aimed to investigate the relationship between antiretroviral medication adherence and CD4 with posttrau-matic stress disorder (PTSD) and depression in patients with HIV.
Methods: This was a descriptive, cross-sectional, quantitative, and correlational study. The statistical popula-tion included all of the patients with HIV in Shiraz, Fars Province, southwest of Iran in 2013, of whom 220 were selected from the Behavioral Diseases Consultation Center using the convenience sampling method. The measures included Mississippi Post Traumatic Stress Disorder Questionnaire, Beck-II Depression, and ACTG Adherence (ACTG). The results were analyzed using the Pearson correlation method and stepwise hierarchical multivariate regression.
Results: Regression analysis showed that of two mediating variables (age & educational level), only age could predict 5% (P<0.001) and of two predictive variables (depression & PTSD) only PTSD could predict 53% (P<0.001) of medication adherence's variance. Moreover, of two mediating variables (age & disease duration), only age could predict 3% (P<0.004) and of two predictive variables (depression & PTSD) only PTSD could predict 4% (P<0.001) of CD4 variance.
Conclusion: The posttraumatic stress disorder symptoms could predict the medication non-adherence and lower CD4 levels.
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2. Mohammadnejad E, Jalalmanesh SH, Mahmoodi M (2009). Clinical syndrome in HIV/AIDS resulting in hospitalization based on the CD4 count. J Mazandaran Univ Med Sci, 19(74): 70-77.
3. Ministry of Health, Treatment and Medi-cal Education (2016). Center for Disease Control. Latest Statistics related to HIV/AIDS infection in Iran.
4. Gallant JE (2000). Strategies for long-term success in the treatment of HIV in-fection. JAMA, 283(10): 1329-1334.
5. Hallet TB, Zaba B, Stover J et al (2014). Embracing different approaches to esti-mating HIV incidence, prevalence and mortality. AIDS, 28(4): S523-32.
6. Valdez AN, Rubin LH, Neigh GN (2016). Untangling the Gordian knot of HIV, stress, and cognitive impairment. Neurobiol Stress, 11(4): 44-54.
7. Bangsberg DR, Acosta EP, Gupta R et al (2006). Adherence-resistance relation-ships for protease and non-nucleoside reverse transcriptase inhibitors explained by virological fitness. AIDS, 20(2): 223–31.
8. Moniz P, Alcada F, Peres S et al (2014). Durability of first Antiretroviral treatment in HIV chronically infected patients: why change and what are the outcomes? J Int AIDS Soc, 17:19797.
9. Belzer ME, Fuchs DN, Luftman GS, Tucker DJ (1999). Antiretroviral adher-ence issues among HIV-positive adoles-cents and young adults. J Adolesc Health, 25(5): 316-9.
10. Johnson RL, Martinez J, Botwinick G et al (2003). Introduction: What youth need_adapting HIV care models to meet the lifestyles and special needs of adoles-cents and young adults. J Adolesc Health, 33(2): 4–9.
11. Spire B, Duran S, Souville M et al (2002). Adherence to highly active antiretroviral therapies (HAART) in HIV-infected pa-tients: from a predictive to a dynamic ap-proach. Soc Sci Med, 54(10):1481-96.
12. Li JZ, Gallien S, Ribaudo H et al (2014). Incomplete adherence to antiretroviral therapy is associated with higher levels of residual HIV-1 viremia. AIDS, 28(2): 181-186.
13. Berg CJ, Michelson SE, Safren SA (2007). Behavioral aspects of HIV care: adher-ence, depression, substance use, and HIV-transmission behaviors. Infect Dis Clin North Am, 21(1): 181-200.
14. Vervoort SC, Borleffs JC, Hoepelman AI, Grypdonck MH (2007). Adherence in an-tiretroviral therapy: a review of qualitative studies. AIDS, 21(3): 271-81.
15. Ammassari A, Trotta MP, Murri R et al (2002). Correlates and predictors of ad-herence to highly active antiretroviral therapy: overview of published literature. J Acquir Immune Defic Syndr, 31(3): S123-7.
16. Deschamps AE, Graeve VD, Van Wijngaerden E et al (2004). Prevalence and correlates of no adherence to an-tiretroviral therapy in a population of HIV patients using Medication Event Monitoring System. AIDS Patient Care STDS, 18(11): 644-57.
17. Leserman J, Ironson G, O’Cleirigh C et al (2008). Stressful life events and adherence in HIV. AIDS Patient Care STDS, 22(5): 403–11.
18. Gore-Felton C, Koopman C (2008). Be-havioral mediation of the relationship be-tween psychosocial factors and HIV dis-ease progression. Psychosom Med, 70(5), 569-74.
19. Catz SL, Kelly JA, Bogart LM et al (2000). Patterns, correlates, and barriers to medi-cation adherence among persons pre-scribed new treatments for HIV disease. Health Psychol, 19(2): 124–33.
20. Safren SA, Gershuny BS, Hendriksen E (2003). Symptoms of posttraumatic stress and death anxiety in persons with HIV and medication adherence difficulties. AIDS Patient Care STDS, 17(12): 657-64.
21. Koopman C, Gore-Felton C, Marouf F et al (2000). Relationships of perceived stress to coping, attachment and social support among HIV-positive persons. AIDS Care, 12(5): 663-72.
22. Neigh GN, Rhodes ST, Valdez A, Jo-vanovic T (2016). PTSD co-morbid with HIV: Separate but equal, or two parts of a whole? Neurobiol Dis, 92:116-23.
23. Moye J, Rouse S (2014). Posttraumatic stress in older adults: When medical di-agnoses or treatments cause trau-matic stress. Clin Geriatr Med, 30: 577-589.
24. Rzeszutek M, Oniszczenko W, Schier K et al (2016). Temperament traits, social sup-port, and trauma symptoms among HIV/AIDS and chronic pain patients. Int J Clin Health Psychol, 16(2): 137-146.
25. Rzeszutek M, Oniszczenko W, Firlag-Burkacka E (2012). Tem-perament traits, coping style and trauma symptoms in HIV+men and women. AIDS Care, 24(9): 1150-4.
26. Boarts JM, Sledjeski EM, Bogart LM, De-lahanty DL (2006). The differential im-pact of PTSD and depression on HIV disease markers and adherence to HAART in people living with HIV. AIDS Behav, 10(3): 253-61.
27. Machtinger EL, Wilson TC, Haberer JE, Weiss DS (2012). Psychological trauma and PTSD in HIV-positive women: A meta-analysis. AIDS Behav, 16(8): 2091-100.
28. Sledgeski EA, Delahanty DL, Bogart LM (2005). Incidence and impact of post-traumatic stress disorder and co morbid depression on adherence to HAART and CD4 counts in people living with HIV. AIDS Patient Care STDS, 19(11): 728-736.
29. Phillips KD, Moneyham L, Murdaugh C et al (2005). Sleep disturbance and depres-sion as barriers to adherence. Clin Nurs Res, 14(3): 273-93.
30. Li L, Lee SJ, Wen Y, Lin C, Wan D, Ji-raphongsa C (2010). Antiretroviral thera-py adherence among patients living with HIV/AIDS in Thailand. Nurs Health Sci, 12(2), 212-20.
31. Simoni JM, Frick PA, Lockhart D, Liebo-vitz D (2002). Mediators of social sup-port and antiretroviral adherence among an indigent population in New York City. AIDS Patient Care STDS, 16(9): 431-9.
32. Avants SK, Margolin A, Warbuton LA et al (2001). Predictors of nonadherence to HIV-related medication regimens during methadone stabilization. Am J Addict, 10(1): 69-78.
33. Vranceanu AM, Safren SA, Lu M et al (2008). The relationship of post-traumatic stress disorder and depression to an-tiretroviral medication adherence in per-sons with HIV. AIDS Patient Care STDS, 22(4): 313-21.
34. Keuroghlian AS, Kamen CS, Neri E et al (2011). Trauma, dissociation, and an-tiretroviral adherence among persons liv-ing with HIV/AIDS. J Psychiatr Res, 45(7): 942-8.
35. Cohen MA, Alfonso CA, Hoffman RG et al (2001). The impact of PTSD on treat-ment adherence in persons with HIV in-fection. Gen Hosp Psychiatry, 23(5): 294-6.
36. Delahanty DL, Bogart LM, Figler JL (2004). Posttraumatic stress disorder symptoms, salivary cortisol, medication adherence, and CD4 levels in HIV-positive individuals. AIDS Care, 16(2): 247-60.
37. Yun WH, Maravi M, Kobayashi JS et al (2005). Antidepressant treatment im-proves adherence to antiretroviral therapy among depressed HIV infected patients. J Acquir Immune Defic Syndr, 38(4): 432-8.
38. Horberg MA, Silverberg MJ, Hurley LB et al (2008). Effects of depression and se-lective serotonin reuptake inhibitor use on adherence to highly active antiretrovi-ral therapy and on clinical outcomes in HIV infected patients. J Acquir Immune Defic Syndr, 47(3): 384-90.
39. Amiri M, Sayehmiri K (2012). Evaluation of Effective Factors on Knowledge and Attitude of People of the City of Ilam Regarding Acquired Immune Deficiency Syndrome. J Ilam Univ Med Sci, 21(1): 1-7.
40. Razavi P, Hajifathalian K, Saeidi B et al (2012). Quality of life among persons with HIV/ AIDS in Iran: Internal Relia-bility and validity of an International In-strument and Associated Factors. AIDS Res Treat, 2012: 849406.
41. Forouzan AS, Jorjoran Shushtari Z, Sajjadi H et al (2013). Social Support Network among People Living with HIV/AIDS in Iran. AIDS Res Treat. 2013:715381.
42. Katibaei J, Hamidi H, Yarian S et al (2010). Comparison of quality of life: stress and mental health of addicts and non-addicts affected by HIV and healthy individuals. J Behav Sci, 4(2): 135-9.
43. Emamipoor S, Shams Esfandabad H, Sadrossadat SJ, Nejadnaderi S (2008). Comparison of mental disorders and quality of life in four groups addicted men affected by AIDS, addicted non-affected by AIDS, non-addicted affected by AIDS and healthy group. J Sharekord Univ Med Sci, 10(1): 69-77.
44. Shakeri J, Parvizifard AA, Aminzadeh S (2001). Mental Status of HIV Positive Pa-tients Reffered to Kernanshah Health Care Center. J Kermanshah Univ Med Sci, 10(1): 31-9.
45. Chesney MA, Ickovics JR, Chambers DB et al (2000). Self-reported adherence to antiretroviral medications among partici-pants in HIV clinical trials: the AACTG Adherence Instruments. AIDS Care, 12(3): 255-66.
46. Goodarzi MA (2003). Evaluation of relia-bility and validity of Mississippi (Echelle) Post-Traumatic Stress Disorder measure. J Psychol, 7(2): 153-178.
47. Groth-Marnat G. Psychological Assessment (Pa-shasharifi & Nikkhoo, Trans). 8th ed. Teh-ran, Sokhan Press, 2003.
48. Dobson KS, Mohammadkhani P (2007). Psychometric characteristics of the Beck Depression Inventory-II in a large sam-ple of patients with major depressive dis-order. J Rehabil, 8(29): 80-86.
49. Nabukeera-Barungi N, Kalyesubula I, Kekitiinwa A et al (2007). Adherence to antiretroviral therapy in children attending Mulago Hospital, Kampala. Ann Trop Pae-diatr, 27(2): 123-31.
50. Kerr T, Palepu A, Barness G et al (2004). Psychosocial determinants of adherence to highly active antiretroviral therapy among injection drug users in Vancouver. Antivir Ther, 9(3): 407-414.
51. Mugavero M, Osterman J, Whetten K et al (2006). Barriers to antiretroviral adher-ence: The importance of depression, abuse, and other traumatic events. AIDS Patient Care STDS, 20(6), 418-28.
52. Wolf MS, Davis TC, Osborn CY et al (2007). Literacy, self-efficacy, and HIV medication adherence. Patient Educ Couns, 65(2): 253-260.
53. McInerney PA, Ncama BP, Wantland D et al (2008). Quality of life and physical functioning in HIV-infected individuals receiving antiretroviral therapy in KwaZu-lu-Natal, South Africa. Nurs Health Sci, 10(4): 266-72.
54. Mo PK, Mak WW (2009). Intentionality of medication non-adherence among indi-viduals living with HIV/AIDS in Hong Kong. AIDS Care, 21(6): 785-95.
2. Mohammadnejad E, Jalalmanesh SH, Mahmoodi M (2009). Clinical syndrome in HIV/AIDS resulting in hospitalization based on the CD4 count. J Mazandaran Univ Med Sci, 19(74): 70-77.
3. Ministry of Health, Treatment and Medi-cal Education (2016). Center for Disease Control. Latest Statistics related to HIV/AIDS infection in Iran.
4. Gallant JE (2000). Strategies for long-term success in the treatment of HIV in-fection. JAMA, 283(10): 1329-1334.
5. Hallet TB, Zaba B, Stover J et al (2014). Embracing different approaches to esti-mating HIV incidence, prevalence and mortality. AIDS, 28(4): S523-32.
6. Valdez AN, Rubin LH, Neigh GN (2016). Untangling the Gordian knot of HIV, stress, and cognitive impairment. Neurobiol Stress, 11(4): 44-54.
7. Bangsberg DR, Acosta EP, Gupta R et al (2006). Adherence-resistance relation-ships for protease and non-nucleoside reverse transcriptase inhibitors explained by virological fitness. AIDS, 20(2): 223–31.
8. Moniz P, Alcada F, Peres S et al (2014). Durability of first Antiretroviral treatment in HIV chronically infected patients: why change and what are the outcomes? J Int AIDS Soc, 17:19797.
9. Belzer ME, Fuchs DN, Luftman GS, Tucker DJ (1999). Antiretroviral adher-ence issues among HIV-positive adoles-cents and young adults. J Adolesc Health, 25(5): 316-9.
10. Johnson RL, Martinez J, Botwinick G et al (2003). Introduction: What youth need_adapting HIV care models to meet the lifestyles and special needs of adoles-cents and young adults. J Adolesc Health, 33(2): 4–9.
11. Spire B, Duran S, Souville M et al (2002). Adherence to highly active antiretroviral therapies (HAART) in HIV-infected pa-tients: from a predictive to a dynamic ap-proach. Soc Sci Med, 54(10):1481-96.
12. Li JZ, Gallien S, Ribaudo H et al (2014). Incomplete adherence to antiretroviral therapy is associated with higher levels of residual HIV-1 viremia. AIDS, 28(2): 181-186.
13. Berg CJ, Michelson SE, Safren SA (2007). Behavioral aspects of HIV care: adher-ence, depression, substance use, and HIV-transmission behaviors. Infect Dis Clin North Am, 21(1): 181-200.
14. Vervoort SC, Borleffs JC, Hoepelman AI, Grypdonck MH (2007). Adherence in an-tiretroviral therapy: a review of qualitative studies. AIDS, 21(3): 271-81.
15. Ammassari A, Trotta MP, Murri R et al (2002). Correlates and predictors of ad-herence to highly active antiretroviral therapy: overview of published literature. J Acquir Immune Defic Syndr, 31(3): S123-7.
16. Deschamps AE, Graeve VD, Van Wijngaerden E et al (2004). Prevalence and correlates of no adherence to an-tiretroviral therapy in a population of HIV patients using Medication Event Monitoring System. AIDS Patient Care STDS, 18(11): 644-57.
17. Leserman J, Ironson G, O’Cleirigh C et al (2008). Stressful life events and adherence in HIV. AIDS Patient Care STDS, 22(5): 403–11.
18. Gore-Felton C, Koopman C (2008). Be-havioral mediation of the relationship be-tween psychosocial factors and HIV dis-ease progression. Psychosom Med, 70(5), 569-74.
19. Catz SL, Kelly JA, Bogart LM et al (2000). Patterns, correlates, and barriers to medi-cation adherence among persons pre-scribed new treatments for HIV disease. Health Psychol, 19(2): 124–33.
20. Safren SA, Gershuny BS, Hendriksen E (2003). Symptoms of posttraumatic stress and death anxiety in persons with HIV and medication adherence difficulties. AIDS Patient Care STDS, 17(12): 657-64.
21. Koopman C, Gore-Felton C, Marouf F et al (2000). Relationships of perceived stress to coping, attachment and social support among HIV-positive persons. AIDS Care, 12(5): 663-72.
22. Neigh GN, Rhodes ST, Valdez A, Jo-vanovic T (2016). PTSD co-morbid with HIV: Separate but equal, or two parts of a whole? Neurobiol Dis, 92:116-23.
23. Moye J, Rouse S (2014). Posttraumatic stress in older adults: When medical di-agnoses or treatments cause trau-matic stress. Clin Geriatr Med, 30: 577-589.
24. Rzeszutek M, Oniszczenko W, Schier K et al (2016). Temperament traits, social sup-port, and trauma symptoms among HIV/AIDS and chronic pain patients. Int J Clin Health Psychol, 16(2): 137-146.
25. Rzeszutek M, Oniszczenko W, Firlag-Burkacka E (2012). Tem-perament traits, coping style and trauma symptoms in HIV+men and women. AIDS Care, 24(9): 1150-4.
26. Boarts JM, Sledjeski EM, Bogart LM, De-lahanty DL (2006). The differential im-pact of PTSD and depression on HIV disease markers and adherence to HAART in people living with HIV. AIDS Behav, 10(3): 253-61.
27. Machtinger EL, Wilson TC, Haberer JE, Weiss DS (2012). Psychological trauma and PTSD in HIV-positive women: A meta-analysis. AIDS Behav, 16(8): 2091-100.
28. Sledgeski EA, Delahanty DL, Bogart LM (2005). Incidence and impact of post-traumatic stress disorder and co morbid depression on adherence to HAART and CD4 counts in people living with HIV. AIDS Patient Care STDS, 19(11): 728-736.
29. Phillips KD, Moneyham L, Murdaugh C et al (2005). Sleep disturbance and depres-sion as barriers to adherence. Clin Nurs Res, 14(3): 273-93.
30. Li L, Lee SJ, Wen Y, Lin C, Wan D, Ji-raphongsa C (2010). Antiretroviral thera-py adherence among patients living with HIV/AIDS in Thailand. Nurs Health Sci, 12(2), 212-20.
31. Simoni JM, Frick PA, Lockhart D, Liebo-vitz D (2002). Mediators of social sup-port and antiretroviral adherence among an indigent population in New York City. AIDS Patient Care STDS, 16(9): 431-9.
32. Avants SK, Margolin A, Warbuton LA et al (2001). Predictors of nonadherence to HIV-related medication regimens during methadone stabilization. Am J Addict, 10(1): 69-78.
33. Vranceanu AM, Safren SA, Lu M et al (2008). The relationship of post-traumatic stress disorder and depression to an-tiretroviral medication adherence in per-sons with HIV. AIDS Patient Care STDS, 22(4): 313-21.
34. Keuroghlian AS, Kamen CS, Neri E et al (2011). Trauma, dissociation, and an-tiretroviral adherence among persons liv-ing with HIV/AIDS. J Psychiatr Res, 45(7): 942-8.
35. Cohen MA, Alfonso CA, Hoffman RG et al (2001). The impact of PTSD on treat-ment adherence in persons with HIV in-fection. Gen Hosp Psychiatry, 23(5): 294-6.
36. Delahanty DL, Bogart LM, Figler JL (2004). Posttraumatic stress disorder symptoms, salivary cortisol, medication adherence, and CD4 levels in HIV-positive individuals. AIDS Care, 16(2): 247-60.
37. Yun WH, Maravi M, Kobayashi JS et al (2005). Antidepressant treatment im-proves adherence to antiretroviral therapy among depressed HIV infected patients. J Acquir Immune Defic Syndr, 38(4): 432-8.
38. Horberg MA, Silverberg MJ, Hurley LB et al (2008). Effects of depression and se-lective serotonin reuptake inhibitor use on adherence to highly active antiretrovi-ral therapy and on clinical outcomes in HIV infected patients. J Acquir Immune Defic Syndr, 47(3): 384-90.
39. Amiri M, Sayehmiri K (2012). Evaluation of Effective Factors on Knowledge and Attitude of People of the City of Ilam Regarding Acquired Immune Deficiency Syndrome. J Ilam Univ Med Sci, 21(1): 1-7.
40. Razavi P, Hajifathalian K, Saeidi B et al (2012). Quality of life among persons with HIV/ AIDS in Iran: Internal Relia-bility and validity of an International In-strument and Associated Factors. AIDS Res Treat, 2012: 849406.
41. Forouzan AS, Jorjoran Shushtari Z, Sajjadi H et al (2013). Social Support Network among People Living with HIV/AIDS in Iran. AIDS Res Treat. 2013:715381.
42. Katibaei J, Hamidi H, Yarian S et al (2010). Comparison of quality of life: stress and mental health of addicts and non-addicts affected by HIV and healthy individuals. J Behav Sci, 4(2): 135-9.
43. Emamipoor S, Shams Esfandabad H, Sadrossadat SJ, Nejadnaderi S (2008). Comparison of mental disorders and quality of life in four groups addicted men affected by AIDS, addicted non-affected by AIDS, non-addicted affected by AIDS and healthy group. J Sharekord Univ Med Sci, 10(1): 69-77.
44. Shakeri J, Parvizifard AA, Aminzadeh S (2001). Mental Status of HIV Positive Pa-tients Reffered to Kernanshah Health Care Center. J Kermanshah Univ Med Sci, 10(1): 31-9.
45. Chesney MA, Ickovics JR, Chambers DB et al (2000). Self-reported adherence to antiretroviral medications among partici-pants in HIV clinical trials: the AACTG Adherence Instruments. AIDS Care, 12(3): 255-66.
46. Goodarzi MA (2003). Evaluation of relia-bility and validity of Mississippi (Echelle) Post-Traumatic Stress Disorder measure. J Psychol, 7(2): 153-178.
47. Groth-Marnat G. Psychological Assessment (Pa-shasharifi & Nikkhoo, Trans). 8th ed. Teh-ran, Sokhan Press, 2003.
48. Dobson KS, Mohammadkhani P (2007). Psychometric characteristics of the Beck Depression Inventory-II in a large sam-ple of patients with major depressive dis-order. J Rehabil, 8(29): 80-86.
49. Nabukeera-Barungi N, Kalyesubula I, Kekitiinwa A et al (2007). Adherence to antiretroviral therapy in children attending Mulago Hospital, Kampala. Ann Trop Pae-diatr, 27(2): 123-31.
50. Kerr T, Palepu A, Barness G et al (2004). Psychosocial determinants of adherence to highly active antiretroviral therapy among injection drug users in Vancouver. Antivir Ther, 9(3): 407-414.
51. Mugavero M, Osterman J, Whetten K et al (2006). Barriers to antiretroviral adher-ence: The importance of depression, abuse, and other traumatic events. AIDS Patient Care STDS, 20(6), 418-28.
52. Wolf MS, Davis TC, Osborn CY et al (2007). Literacy, self-efficacy, and HIV medication adherence. Patient Educ Couns, 65(2): 253-260.
53. McInerney PA, Ncama BP, Wantland D et al (2008). Quality of life and physical functioning in HIV-infected individuals receiving antiretroviral therapy in KwaZu-lu-Natal, South Africa. Nurs Health Sci, 10(4): 266-72.
54. Mo PK, Mak WW (2009). Intentionality of medication non-adherence among indi-viduals living with HIV/AIDS in Hong Kong. AIDS Care, 21(6): 785-95.
| Files | ||
| Issue | Vol 48 No 1 (2019) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v48i1.802 | |
| Keywords | ||
| Antiretroviral medication adherence CD4 cells Depression Post traumatic stress disorder | ||
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How to Cite
1.
EBRAHIMZADEH Z, GOODARZI MA, JOULAEI H. Predicting the Antiretroviral Medication Adherence and CD4 Measure in Patients with HIV/AIDS Based on the Post Traumatic Stress Disorder and Depression. Iran J Public Health. 2019;48(1):139-146.
