Effects of Unknown Infant HIV Serostatus on Maternal Perceptions of Stress, Distress, Social Support, and Maternal and Baby Adherence to HIV Medications

Maureen Shannon, UC-San Francisco
HIV/AIDS Policy & Health Care Financing

Background: The primary objective of the study is to describe perceptions of maternal uncertainty, stress and distress in HIV-infected women in association with the unknown HIV status of their infants and to document changes in these variables over time. Secondary objectives include determining relationships between maternal social support and perceptions of stress and distress; and between levels of maternal stress and distress and adherence to antiretroviral medications in the mothers and their infants. In California, the majority of women with HIV infection are in their childbearing years. HIV-infected women who become pregnant receive highly active antiretroviral therapy (HAART) both to reduce perinatal HIV transmission as well as to delay maternal disease progression. The use of HAART significantly reduces the risk of perinatal transmission from 25% to less than 2%.As a result, the vast majority of HIV-infected pregnant women are expected to give birth to uninfected, healthy infants. However, the HIV status of these infants is not immediately known and requires several HIV-specific viral laboratory tests during the first few months of life to determine their infection status. Ninety-nine percent of infected infants are diagnosed during the first four months of life and negative HIV viral test results during this time can be reassuring to parents. However, maternal perceptions of uncertainty about an infant's HIV infection status during the testing period can contribute to psychological and physiological distress. Perceptions of stress and distress in HIV-infected individuals have been associated with erratic adherence to antiretroviral medications, alterations in immune function and increased mortality rates. In addition, inconsistent maternal adherence to HIV medications has been linked to sub-optimal administration of HIV prophylactic medications to perinatally-exposed infants, thereby increasing the risk of infection in these infants.

Methods: This is a prospective, repeated measures study of HIV-infected mothers and their infants designed to describe the effects of unknown infantHIV statuson:(1.)maternalperceptions of uncertainty; (2.) maternal perceptions of stress; (3.) maternal perceptions of psychological distress;(4.) maternal social support; and (5.) adherence to maternal and infant HIV medications. Study variables are measured in women at six time points (once during the thirdtrimesterof pregnancy andfive times afterdelivery).Data are collected using standardized questionnaires and open-ended questions. Maternal and infant medical records are abstracted to confirm their health status. Data analyses include repeated measures analysis of variance for quantitative responses and content analysis for qualitative responses.

Results/Expected Results: Demographic data for the 12 enrolled maternal subjects are as follows: mean age = 31. 9 (range = 21-43); ethnicity/race = 41% Black (non-Hispanic), 41% White (non-Hispanic), 9% Hispanic, 9% Native American/ Hispanic; HIV/AIDS stage: 33% with an AIDS diagnosis prior to the current pregnancy. Five maternal subjects have completed data collection, and all of their infants are uninfected by HIV DNA PCR testing.

Conclusions: This study has been designed to investigate aspects of maternal stress, distress, coping and medication adherence that have not been addressed previously in HIV-infected childbearing women. Information gained from this study will provide a foundation for developing interventions that may improve maternal and infant health outcomes during this potentially stressful period.