Educational attainment and response to HAART during initial therapy for HIV-1 infection.

TitleEducational attainment and response to HAART during initial therapy for HIV-1 infection.
Publication TypeJournal Article
Year of Publication2007
AuthorsMarc LG, Testa MA, Walker AM, Robbins GK, Shafer RW, Anderson NB, Berkman LF
Corporate AuthorsACTG Data Analysis Concept Sheet Study Team
JournalJ Psychosom Res
Volume63
Issue2
Pagination207-16
Date Published2007 Aug
ISSN0022-3999
KeywordsAchievement, Antiretroviral Therapy, Highly Active, Double-Blind Method, Female, HIV Infections, HIV-1, Humans, Male, Patient Compliance, Self Efficacy, Surveys and Questionnaires
Abstract

OBJECTIVE: Previous research has demonstrated an association between educational attainment (EA) and negative physical and psychological outcomes. This study investigated whether EA is associated with regimen failure during initial therapy with highly active antiretroviral treatment (HAART) and whether adherence self-efficacy (ASE), a coping resource, moderates the relationship between EA and regimen failure.

METHODS: A secondary analysis of AIDS Clinical Trial Group Protocol 384, an international, multicenter, randomized, partially double-blinded trial, included 799 male and 181 female antiretroviral-naïve subjects (age, 37.0+/-9.5 years). Participants were recruited from 1998 to 1999 and followed for a median of 2.3 years across 81 centers. The dependent variable was "time to first regimen failure." Covariates include baseline HIV-1 log(10)RNA and CD4(+) counts, self-reported adherence, study site, ASE, age, sex, race, treatment assignment, and baseline use of nonantiretroviral medications.

RESULTS: ASE significantly moderated the relationship between EA and regimen failure. Results showed that for every 10-unit increase in ASE, individuals with "less than high school" education had a 17% reduction in regimen failure (hazard ratio=0.83; 95% confidence interval=0.70-0.98) when compared to the reference group "college/graduate," even after adjusting for baseline factors known to contribute to regimen failure. The time to first regimen failure was shorter with decreasing EA, trending toward significance (P=.08).

CONCLUSIONS: There is a social gradient in HAART effectiveness, and ASE reduces the deleterious effects of lower EA on regimen failure. We recommend designing controlled interventions to evaluate the effectiveness of programs that increase ASE prior to initiation with HAART, particularly for those with lower EA.

DOI10.1016/j.jpsychores.2007.04.009
Alternate JournalJ Psychosom Res
PubMed ID17662759
Grant ListAI-69419 / AI / NIAID NIH HHS / United States
AI25868 / AI / NIAID NIH HHS / United States
AI25924 / AI / NIAID NIH HHS / United States
AI27659 / AI / NIAID NIH HHS / United States
AI38858 / AI / NIAID NIH HHS / United States
MH19132 / MH / NIMH NIH HHS / United States