Antiretroviral treatment adherence as a mediating factor between psychosocial variables and HIV viral load

J Assoc Nurses AIDS Care. Nov-Dec 2014;25(6):626-37. doi: 10.1016/j.jana.2014.08.001. Epub 2014 Aug 8.


Psychosocial factors may directly impact HIV health measures such as viral load (VL) whether or not patients are taking antiretroviral treatment (ART) consistently. Structural equation modeling plus Baron and Kenny's (1986) four-step approach were used to test a mediated model predicting VL among 246 HIV-infected adults who were on ART. Exogenous variables were social support, barriers to adherence, and stress. Moderators were alcohol use, marijuana use, and neurocognitive impairment. A small positive association between marijuana use and ART adherence approached significance. Only barriers to adherence predicted a decrease in adherence rates and an increase in VL. No other factors were significantly associated with either VL or adherence, and no interaction effects between exogenous variables and moderators were identified. The association between barriers to adherence and VL was partially mediated by ART adherence. Findings provide modest support for a direct link between psychosocial variables and a virologic response to ART.

Keywords: HIV; adherence; alcohol; antiretroviral; marijuana; psychosocial; treatment; viral load.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Alcohol Drinking
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active*
  • CD4 Lymphocyte Count
  • Cross-Sectional Studies
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / psychology
  • HIV Infections / virology*
  • HIV-1 / drug effects*
  • Humans
  • Male
  • Medication Adherence*
  • Social Support
  • Socioeconomic Factors
  • Stress, Psychological / diagnosis
  • Stress, Psychological / psychology
  • Treatment Outcome
  • Viral Load


  • Anti-HIV Agents