Factors and mechanisms of instability of adherence to antiretroviral therapy during long-term treatment: a cascade model
Objective. Assessment of the contribution of psychoemotional, cognitive, and behavioral factors to adherence to antiretroviral therapy (ART) and quality of life indicators in patients with HIV infection during long-termBelyaeva V.V., Sokolova E.V., Kozyrina N.V., Kuimova U.A., Goliusova M.D., Kulabukhova E.I.
follow-up.
Materials and methods. The study was conducted as a dynamic clinical cohort with partially overlapping samples (2023–2025). The analysis included sequential stages of examination of patients with a confirmed diagnosis of HIV infection receiving long-term ART. Suboptimal health status (SHSQ-25), coping strategies, locus of control, rehabilitation potential, integrated adherence (CAS-25), quality of life (SF-36), self-assessed health, and missed ART doses in the previous month were assessed.
Results. With clinical and immunological stability (absence of HIV progression, secondary diseases, median CD4⁺ value of 722 cells/μL, undetectable viral load), signs of suboptimal health were detected in 44.1% of patients; vulnerability of the mental component of quality of life was detected in 48.8%. For the majority of respondents, integrated adherence was in the zone of potential instability; high levels were detected in 26.4%. Missed ART sessions correlated with self-rated health, rehabilitation potential, and its emotional and communicative components. In a multivariate model, the emotional (OR 0.76; p = 0.031) and communicative (OR 1.74; p = 0.026) components of rehabilitation potential were independent predictors of missed sessions; a trend toward a lower risk of missed sessions was noted with higher self-rated health (p = 0.060). Signs of cognitive difficulties were associated with decreased adherence to medical care.
Conclusion. In clinically stable HIV infection, the stability of ART adherence is determined not only by biomedical indicators but also by psychoemotional, cognitive, and behavioral factors. Self-rated health and components of rehabilitation potential can be considered early markers of the risk of unstable adherence. Integrating their assessment into routine monitoring facilitates personalized therapy support and improves patients' quality of life.
Keywords
HIV infection
antiretroviral therapy
treatment adherence
psychoemotional factors
behavioral destabilization cascade
References
1. Соколова Е.В., Ладная Н.Н., Покровский В.В., Кравченко А.В., Козырина Н.В., Юрин О.Г. и др. Влияние антиретровирусной терапии на развитие эпидемии ВИЧ-инфекции в Российской Федерации. Эпидемиол. инфекц. болезни. Актуал. вопр. 2023; 13(3): 20–26. [Sokolova E.V., Ladnaya N.N., Pokrovsky V.V., Kravchenko A.V., Kozyrina N.V., Yurin O.G. et al. The impact of antiretroviral therapy on the development of the HIV epidemic in the Russian Federation. Epidemiоlоgy and infectious diseases. Сurrent items 2023; 13(3): 20–26. (In Russ.)]. DOI: 10.18565/epidem.2023.13.3.20-6
2. European AIDS Clinical Society (EACS). Guidelines. Version 12.0. Brussels: EACS; 2023.
3. Deeks S.G., Lewin S.R., Havlir D.V. The end of AIDS: HIV infection as a chronic disease. Lancet 2013; 382(9903): 1525–1533. DOI: 10.1016/S0140-6736(13)61809-7
4. Ortego C., Huedo-Medina T.B., Llorca J., Sevilla L., Santos P., Rodríguez E. et al. Adherence to highly active antiretroviral therapy: a meta-analysis. AIDS Behav. 2011; 15(7): 1381–1396. DOI: 10.1007/s10461-011-9942-x
5. Gonzalez J.S., Batchelder A.W., Psaros C., Safren S.A. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J. Acquir. Immune Defic. Syndr. 2011; 58(2): 181–187. DOI: 10.1097/QAI.0b013e31822d490a
6. Uthman O.A., Magidson J.F., Safren S.A., Nachega J.B. Depression and adherence to antiretroviral therapy: a systematic review and meta-analysis. Curr. HIV/AIDS Rep. 2014; 11(3): 291–307. DOI: 10.1007/s11904-014-0220-1
7. Беляева В.В., Соколова Е.В., Козырина Н.В., Куимова У.А., Голиусова М.Д., Кулабухова Е.И. Результаты анализа субоптимального уровня здоровья пациентов, принимающих антиретровирусную терапию. Журнал инфектологии 2024; 16(2S1): 23–27. [Belyaeva V.V., Sokolova E.V., Kozyrina N.V., Kuimova U.A., Goliusova M.D., Kulabukhova E.I. Results of the analysis of suboptimal health status in patients receiving antiretroviral therapy. Jurnal Infektology 2024; 16(2S1): 23–27. (In Russ.)].
8. Беляева В.В., Соколова Е.В., Козырина Н.В., Кулабухова Е.И., Голиусова М.Д. Стратегии поведения, направленные на совладание со стрессом, пациентов, длительное время принимающих антиретровирусную терапию. Материалы IX Санкт-Петербургского форума по ВИЧ-инфекции с международным участием. СПб.; 2024: 4–10. [Belyaeva V.V., Sokolova E.V., Kozyrina N.V., Kulabukhova E.I., Goliusova M.D. Coping strategies in patients receiving long-term antiretroviral therapy. Proceedings of the X St. Petersburg Forum on HIV Infection with International Participation. . St. Petersburg; 2024: 4–10. (In Russ.)].
9. Беляева В.В., Соколова Е.В., Козырина Н.В., Кулабухова Е.И., Голиусова М.Д. Результаты оценки субъективного контроля у пациентов, инфицированных ВИЧ, как маркера риска нарушения приверженности. Материалы IX Санкт-Петербургского форума по ВИЧ-инфекции с международным участием. СПб.; 2024: 87–88. [Belyaeva V.V., Sokolova E.V., Kozyrina N.V., Kulabukhova E.I., Goliusova M.D. Results of the assessment of subjective control in HIV-infected patients as a marker of the risk of non-adherence. Proceedings of the X St. Petersburg Forum on HIV Infection with International Participation. St. Petersburg; 2024: 87–88. (In Russ.)].
10. Беляева В.В., Козырина Н.В., Соколова Е.В., Голиусова М.Д., Кулабухова Е.И. Результаты оценки реабилитационного потенциала пациентов, принимающих антиретровирусную терапию. Эпидемиол. инфекц. болезни. Актуал. вопр. 2025; 15(3): 63–68. [Belyaeva V.V., Kozyrina N.V., Sokolova E.V., GoliusovaM.D., Kulabukhova E.I. Results of assessment of rehabilitation potential of patients taking antiretroviral therapy. Epidemiology and infectious diseases. Current items 2025; 15(3): 63–68. (In Russ.)]. DOI: 10.18565/epidem.2025.15.3.63-68
11. Козырина Н.В., Беляева В.В., Соколова Е.В., Михайлова Н.А., Кулабухова Е.И., Голиусова М.Д. и др. Результаты скрининга нейрокогнитивных нарушений у людей, живущих с ВИЧ. Материалы IX Санкт-Петербургского форума по ВИЧ-инфекции с международным участием. СПб.; 2024: 117–118. [Kozyrina N.V., Belyaeva V.V., Sokolova E.V., Mikhailova N.A., Kulabukhova E.I., Goliusova M.D. et al. Results of screening for neurocognitive impairment in people living with HIV. Proceedings of the X St. Petersburg Forum on HIV Infection with International Participation. St. Petersburg; 2024: 117–118. (In Russ.)].
12. Беляева В.В., Соколова Е.В., Козырина Н.В., Голиусова М.Д., Куимова У.А., Кулабухова Е.И. Результаты анализа качества жизни и самооценки здоровья пациентов, длительное время принимающих антиретровирусную терапию. Материалы X Санкт-Петербургского форума по ВИЧ-инфекции с международным участием. СПб.; 2025: 18–25. [Belyaeva V.V., Sokolova E.V., Kozyrina N.V., Goliusova M.D., Kuimova U.A., Kulabukhova E.I. Results of the analysis of quality of life and self-rated health in patients receiving long-term antiretroviral therapy. Proceedings of the X St. Petersburg Forum on HIV Infection with International Participation. St. Petersburg; 2025: 18–25. (In Russ.)].
13. Wykowski J., Kemp C.G., Velloza J. Associations between anxiety and adherence to antiretroviral medications in low- and middle-income countries: a systematic review and meta-analysis. AIDS Behav. 2019; 23(8): 2059–2071. DOI: 10.1007/s10461-018-02390-8
14. Johnson M.O., Neilands T.B., Dilworth S.E., Morin S.F., Remien R.H., Chesney M.A. The role of self-efficacy in HIV treatment adherence: validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). J. Behav. Med. 2007; 30(5): 359–370. DOI: 10.1007/s10865-007-9118-3
15. Lovejoy T.I., Suhr J.A. The relationship between neuropsychological functioning and HAART adherence in HIV-positive adults: a systematic review. J. Behav. Med. 2009; 32(5): 389–405. DOI: 10.1007/s10865-009-9212-9
16. Hendershot C.S., Stoner S.A., Pantalone D.W., Simoni J.M. Alcohol use and antiretroviral adherence: review and meta-analysis. J. Acquir. Immune Defic. Syndr. 2009; 52(2): 180–202. DOI: 10.1097/QAI.0b013e3181b18b6e
About the Authors
Valentina V. Belyaeva, MD, Leading Researcher, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; labora-et-ora@yandex.ru; http://orcid.org/0000-0002-4621-7892Ekaterina V. Sokolova, Cand. Med. Sci., Researcher, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; ekaterinasokolova007@rambler.ru; http://orcid.org/0000-0002-2001-8772
Nadezhda V. Kozyrina, Cand. Med. Sci., Senior Researcher, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; nad-kozyrina@yandex.ru; http://orcid.org/0000-0001-5134-0054
Ulyana A. Kuimova, Cand. Med. Sci., Researcher, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; ulyanakuimova@gmail.com; http://orcid.org/0000-0002-1101-151X
Marina D. Goliusova, Infectiologist, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; mad2501@yandex.ru
Ekaterina I. Kulabukhova, Cand. Med. Sci., Infectiologist, Central Research Institute of Epidemiology, Federal Service for Supervision of Consumer Rights Protection and Human Well-Being; Assistant, Department of Infectious Diseases with Courses in Epidemiology and Phthisiology, Medical Institute, RUDN University, Moscow, Russia; ekulabukhova@mail.ru; http://orcid.org/0000-0003-3645-7275
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