Author(s)

Corrado Cancedda, Katherine S. Eddens, Olumuyiwa Adebona, Revathi Ravi, Enbal Shacham, Edgar Turner Overton

Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA.
George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, USA.
Texas Tech University Health Sciences Center, Lubbock, USA.

Socially disadvantaged individuals with HIV experience unacceptably high rates of AIDS and death. The authors developed an adversity index to quantify the impact of demographic and psychosocial factors on HIV care. This retrospective cohort study included 431 participants with HIV on combined antiretroviral therapy between 2000 and 2005. Poor outcome was defined as progression to AIDS, death, virologic failure, or CD4 < 200 cells/μl at six months. The index utilized eight demographic and psychosocial variables independently associated with poor outcome. Exposure to higher numbers of variables in the adversity index significantly increased the rates of poor outcome from 14% (exposure to no variables) to 100% (exposure to seven variables). The odds of poor outcome decreased but remained significant after adjusting for adherence-defining variables, indicating a possible mediating effect of poor adherence. Durably effective therapeutic strategies must include addressing adverse demographic and psychosocial factors affecting people living with HIV.

HIV; Outcomes; Psychosocial; Adversity; Adherence

C. Cancedda, K. S. Eddens, O. Adebona, R. Ravi, E. Shacham and E. Turner Overton, "The Detrimental Effect of Adversity on HIV Outcomes in the Era of Combined Anti-Retroviral Therapy," World Journal of AIDS, Vol. 2 No. 4, 2012, pp. 338-346. doi: 10.4236/wja.2012.24045.