Among persons with HIV (PWH), trauma symptoms (TS) are a barrier to achieving HIV control. We sought to determine factors associated with TS among PWH and the association of TS with viral suppression.
In the Johns Hopkins HIV Clinical Cohort (JHHCC) between 2013-2018, we measured trauma symptoms using the Primary Care Post Traumatic Stress Disorder Screen (PC-PTSD). We categorized TS as a PC-PTSD score ≥3. Prevalence of TS was examined by model based recursive partitioning allowing for repeated measures. Factors hypothesized to be associated with TS included age, race, depressive (PHQ-8≥5), anxiety symptoms (GAD-7≥5), cocaine, heroin, and hazardous alcohol. Logistic regression with generalized estimating equations was used to examine the association of TS with viral suppression. Models were stratified by gender.
Our analytic sample included 666 cis-gender women (89% African American (AA), 30% IDU as risk factor for HIV acquisition, 65%<55 years old), and 1154 cis-gender men (78% AA, 33% IDU, 59%<55 years old). At baseline, prevalence of TS was 10.4% among women and 8% among men. PWH with TS at baseline had lower ART adherence (visual analogue scale<90 35 vs 17%, p<0.001), less viral suppression (56 vs. 76% p=0.1), more depression (88 vs. 39%, p<0.001), and anxiety (85 vs. 16%, p<0.001), and greater substance use (hazardous alcohol: 31 vs 17%; cocaine: 13 vs 4.4%; heroin: 20 vs. 8.3%, all p<0.001) compared to PWH without TS. Among women, the co-occurrence of anxiety and depressive symptoms was associated with an increased prevalence of TS reaching 41% (figure, node 5) TS compared to 1% (node 2) among those without anxiety irrespective of depressive symptoms. For men, the prevalence of TS among those with anxiety and depressive symptoms was 38% (node 9), followed by those without anxiety, but with co-occurring depressive symptoms and hazardous alcohol use (20%, node 6). Among both women and men, those with TS were had similar risk of being virally suppressed as compared to those without TS (women: risk difference= -11%, 95%CI: -27, 5; men: RD= -2%, 95%CI: -13, 7).
Overall prevalence of TS is high and related to other psychiatric comorbidities among PWH. Adding TS screening would significantly increase identification of overall psychiatric morbidity. While TS by itself was not related to non-suppression, it is likely that treatment of overall psychiatric morbidity together may potentially decrease the risk of viral non-suppression.