Spiritual coping predicts CD4-cell preservation and undetectable viral load over four years

Abstract

In this study of 177 people living with HIV, we examined if spiritual coping leads to slower HIV disease progression (CD4 cells, viral load [VL]), and more positive health behaviors (adherence, safer sex, less substance use). Prior research suggests that physicians' assessment of spiritual coping can be an interventional aid in promoting positive spiritual coping. Longitudinal spiritual coping was rated using qualitative content analysis of six-monthly interviews/essays. Positive spiritual coping (65%) was predominant over negative (7%), whereas 28% did not make significant use of spirituality as a means to cope. Spiritual coping was associated with less substance use disorder but not with less sexual risk behavior. Hierarchical linear modeling demonstrated that spiritual coping predicted sustained undetectable VL and CD4-cell preservation over four years, independent of sociodemographics, baseline disease status, and substance use disorder. Achieving undetectable VL significantly increased over time in participants with positive spiritual coping but decreased among those with negative spiritual coping. For every participant with positive spiritual coping achieving undetectable VL, four with negative spiritual coping reported with detectable/transmittable HIV. Notably, even when controlling for the effect of VL suppression, CD4-cell decline was 2.25 times faster among those engaged in negative versus positive spiritual coping. In conclusion, spiritual coping is associated with positive health behaviors, such as maintaining long-term VL suppression and less onset/relapse of substance use disorder over time. Among those who are sexually active, positive spiritual coping reduces the risk of HIV transmission via VL suppression but may not prevent the transmission of other STDs because spiritual coping is not related to safer sexual behavior. Notably, the association between spiritual coping and immune preservation was direct (i.e., not explained by VL suppression), suggesting potential psychoneuroimmunological pathways. Thus, assessment of spiritual coping may be an important area of intervention to achieve undetectable VL, reduce HIV disease progression, and prevent substance use onset/relapse.

Keywords:

• HIV
• spirituality
• coping
• disease progression
• prevention

Acknowledgments

We thank all people living with HIV for sharing their personal experiences with us. We also thank the positive survivors research team for running the longitudinal study, in particular Annie George for conducting most of the interviews, the research assistants Tony Guerra and Marietta Suarez for their help with the coding agenda, Franz Lutz for his suggestion to create a Wiki for the coding agenda, all the students for their enormous help in transcribing and coding of the interviews and essays, and Monica Mangra and Nicoleta DeDeugd for their editorial comments.

Funding

We thank the John Templeton Foundation for the two-year funding of this secondary data analysis, the Fetzer Institute for funding more in-depth transcripts, and the NIH [grant number R01MH53791], [grant number R01MH066697] (PI: Gail Ironson) and the Metanexus Institute for financing the longitudinal study.

Additional information

Funding

Funding We thank the John Templeton Foundation for the two-year funding of this secondary data analysis, the Fetzer Institute for funding more in-depth transcripts, and the NIH [grant number R01MH53791], [grant number R01MH066697] (PI: Gail Ironson) and the Metanexus Institute for financing the longitudinal study.