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Beyond Viral Suppression—The Impact of Cumulative Violence on Health-Related Quality of Life Among a Cohort of Virally Suppressed Patients

Objective: To elucidate how and in what ways cumulative violence affects health-related quality of life (HRQoL) among a clinical cohort of virally stable people living with HIV. Design: We used data from the University of North Carolina Center for AIDS Research HIV clinical cohort. Our analysis was limited to participants with an undetectable viral load (<200) and those who completed the Clinical, Sociodemographic, and Behavioral Survey between 2008 and 2017 (n = 284). Methods: A path analysis was used to test our primary hypothesis that the effect of cumulative violence on HRQoL would be mediated through symptoms of post-traumatic stress disorder (PTSD), depressive symptoms, and HIV symptom distress. Results: The impact of cumulative violence on HRQoL was fully mediated by symptoms of PTSD, depressive symptoms, and HIV symptom distress. Greater exposure to violence was associated with higher odds of PTSD symptoms (P <0.001), increased depressive symptoms (P <0.001), and increased HIV symptom distress (P < 0.01). HIV symptom distress displayed the largest association with HRQoL (P < 0.001), followed by depressive symptoms (P = 0.001) and PTSD symptoms (P < 0.001). These factors explained approximately 51% of the variance in HRQoL (R2 = 0.51, P < 0.001). Conclusions: Our findings indicate that addressing physical and mental health symptoms rooted in violent victimization should be a point of focus in efforts to improve HRQoL among people living with HIV who are virally stable.