Intertwining health problems – syndemics – are associated with higher viral load and poorer adherence in HIV-positive men who have sex with men (MSM) taking antiretroviral treatment (ART), investigators from the United States report in the online edition of AIDS.
“Higher HIV viral load and lower ART adherence are, respectively, associated with increased syndemics count,” explain the authors. “These findings indicate that combinations of depression symptoms, polysubstance use and sexual risk behaviour function as profound barriers to fully reaping the benefits of successful HIV care and that, as these conditions snowball, their impact on HIV outcomes is exacerbated.”
They believe their findings have important implications for current treatment as prevention strategies to control the HIV epidemic, as every increase in the number of epidemics was associated with higher viral load and therefore transmission risk.
Men who have sex with men account for approximately two-thirds of new HIV diagnoses in the United States. There are great hopes that the use of antiretroviral treatment as prevention will help curtail the epidemic in this population. However, only 28% of people with HIV in the US have an undetectable viral load.
Investigators from the Multicentre AIDS Cohort Study (MACS) were concerned that there were significant barriers preventing MSM with HIV from achieving and maintaining an undetectable viral load.
It is possible that syndemics (intertwining health problems) such as adversity and trauma in early life are associated with depression and substance abuse in young adulthood, which in turn leads to sexual risk-taking.
To see if this is the case, investigators assessed the association of syndemics on adherence and viral load in 766 MSM living with HIV who received care between 2003 and 2009.