Friedman M Reuel, Stall Ron, Silvestre Anthony J, Wei Chongyi, Shoptaw Steve, Herrick Amy, Surkan Pamela J, Teplin Linda, Plankey Michael W
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.
AIDS. 2015 Jun 1;29(9):1087-96. doi: 10.1097/QAD.0000000000000657.
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.
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.
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.
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).
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.
本研究的目的是确定合并流行症（综合征）与HIV阳性男男性行为者的HIV药物依从性及病毒载量水平之间的关联，并检验依从性是否介导了综合征与病毒载量之间的关系。
我们分析了2003年至2009年期间从多中心艾滋病队列研究中收集的参与者数据，该研究是在美国四个城市进行的一项前瞻性HIV/艾滋病队列研究。
我们进行了纵向分析（重复测量混合模型），以评估病毒载量水平、不可检测的病毒载量和自我报告的HIV药物依从性差异是否与合并流行症状况（物质使用、抑郁症状和性风险行为，范围为0至3）的计数相关，并对种族/民族、年龄和收入进行了调整。使用结构方程模型和SAS %mediate宏进行中介分析。
合并流行症计数与较高的病毒载量（P < 0.0001）和较低的依从性（P < 0.0001）相关。合并流行症的计数增加与病毒载量（P < 0.01）、可检测的病毒载量（P < 0.05）和依从性（P < 0.001）相关。黑人男男性行为者在各个领域的结果比白人男男性行为者更差（P < 0.0001），且合并流行症的总体发生率更高（P < 0.01）。依从性显著介导了合并流行症与病毒载量之间的关系，估计占效应的32.3%（P < 0.05）。
有效降低男男性行为者的病毒载量水平对HIV/艾滋病的预防和护理都有影响。我们的研究结果表明，将物质使用干预、精神卫生保健和性风险预防纳入标准的HIV护理中，可能是优化治疗和预防治疗（TasP）模式所必需的。
