Viral Snobbery?

An HIVer's social and economic status can be used to determine how effective antiretroviral treatment will be during initial therapy, according to a study published in the August issue of the Journal of Psychosomatic Research. The effect has even been found among subjects with high rates of drug adherence. Researchers in the study--conducted by a team from Harvard School of Public Health, Massachusetts General Hospital, Stanford University Medical School, and the American Psychological Association--used data from a clinical trial that recruited HIV-positive men and women in the United States and Italy who had not previously taken any anti-HIV medications. The study participants were then treated with combination antiretroviral therapy. Experts have previously suggested that stress and emotional distress predict a faster decline in the immune system cells that can fight HIV's progression. Previous studies have also shown that people at lower socioeconomic positions often report chronic stresses in life. The researchers in this study wanted to examine whether socioeconomic position, based on education level, would influence immune functioning and response to antiretroviral treatments--even if patients adhered to their antiretroviral drugs. The study's authors documented the length of time until a participant first experienced a regimen failure, meaning that the drug combination failed to maintain low HIV levels in the bloodstream or that anti-HIV meds needed to be changed or stopped. The researchers found that participants with lower levels of education reached initial regimen failure faster than participants with a college- or graduate-level degree. However, participants with high levels of 'adherence self-efficacy,' despite lower education levels, experienced a reduction in initial regimen failure by 15% to 17%. Adherence self-efficacy was described as a coping resource that reflected the strength of the patient's belief in the effectiveness of their medication and their ability to adhere to their treatment regimen. The authors suggest that one reason behind this association might be that coping styles are often associated with better immune functioning in individuals with HIV disease. 'These findings support health promotion programs focusing on psychological and behavioral aspects associated with therapeutic regimens,' says Linda Marc, who led the research project while a doctor of science candidate in the department of Society, Human Development, and Health at Harvard School of Public Health.