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The relationships among stress-responsive biomarkers, ART adherence, and viral suppression among adolescent girls and young women living with HIV in South Africa
An HPTN 068 analysis
Stoner, M. C. D., Kelly, N. K., Gomez-Olive, F. X., Kahn, K., Wagner, D., Bhushan, N. L., Aiello, A. E., & Pettifor, A. E. (2023). The relationships among stress-responsive biomarkers, ART adherence, and viral suppression among adolescent girls and young women living with HIV in South Africa: An HPTN 068 analysis. Journal of acquired immune deficiency syndromes (1999), 92(5), 349-358. https://doi.org/10.1097/QAI.0000000000003149
BACKGROUND: Adolescent girls and young women (AGYW) living with HIV who have higher stress levels may be at risk for stress-related biological alterations, which could influence HIV progression and adherence to antiretroviral therapy (ART).
SETTING: We aimed to estimate associations among stress-responsive biomarkers, ART adherence and viral suppression in AGYW living with HIV in South Africa. We also hypothesized that psychosocial stressors (e.g., depression, food insecurity, low socioeconomic status (SES), HSV-2) would be associated with higher biomarker levels.
METHODS: We utilized 2018/2019 data from the HIV Prevention Trials Network (HPTN) 068 cohort to assess associations between stress-responsive biomarkers and viral suppression (<1000 copies/mL) and ART adherence measured using dried blood spot (DBS) cards. Stress-responsive biomarkers included C-reactive protein (CRP), Herpes simplex virus type 1 (HSV-1), and cytomegalovirus (CMV) infection and reactivation. Associations were estimated using unadjusted log-binomial or ordinal logistic regression models.
RESULTS: In 166 AGYW living with HIV, there was no association between stress-responsive biomarkers and viral suppression or ART adherence. However, increased CRP levels were associated with higher HSV-2 infection (odds ratio (OR) 1.98; 95% confidence interval (CI) 1.11, 3.52), being a government grant recipient (OR 3.21; 95% CI 1.30, 7.92), lower food insecurity (OR 0.34; 95% CI 0.13, 0.90) and increased BMI (OR 1.07; 95% CI 1.01, 1.14).
CONCLUSIONS: High prevalence of psychosocial stressors and persistent herpesviruses in AGYW living with HIV has the potential to lead to poorer health outcomes. More research is needed to untangle relationships between economic stability, chronic disease, and chronic stress.
