Intimate Partner Violence: A Predictor of Worse HIV Outcomes and Engagement in Care

For HIV-infected patients, experiencing multiple traumas is associated with AIDS-related and all-cause mortality, increased opportunistic infections, progression to AIDS, and decreased adherence to therapy. The impact of intimate partner violence (IPV) on adherence and HIV outcomes is unknown. HIV-infected patients recruited from a public HIV clinic participated in this observational cohort study (n = 251). Participants completed interviews evaluating IPV and covariates. CD4 count <200 (CD4 <200), detectable HIV viral load (VL), and engagement in care (no show rate [NSR]) were the outcomes of interest. Medication adherence was not measured. Univariate and multivariate regression analyses were performed with covariates included if p < 0.3 in the univariate phase. Seventy-four percent of the participants were male, 55% Caucasian, and 52.2% self-identified as men who have sex with men. IPV prevalence was 33.1% with no difference by gender or sexual orientation. In univariate analysis, IPV exposure predicted having a CD4 < 200 (p = 0.005) and a detectable VL (p = 0.04) but trended toward significance with a high NSR (p = 0.077). Being threatened by a partner was associated with a CD4 < 200 (p = 0.005), a detectable VL (p = 0.011), and high NSR (p = 0.019) in univariate analysis. In multivariate analysis, IPV predicted having a CD4 < 200 (p = 0.005) and detectable VL (p = 0.035). Being threatened by a partner predicted having a CD4 < 200 (p = 0.020), a detectable VL (p = 0.007), and a high NSR (p = 0.020). Our results suggest IPV impacts biologic outcomes and engagement in care for HIV-infected patients. IPV alone predicts worse biologic outcomes, whereas the specific experience of being threatened by a partner was associated with all three outcomes in univariate and multivariate analyses.