Depression Can Interfere With HIV Treatment Outcomes

Longer bouts of depression can increase the risk of treatment failure and, in turn, lead to worsened outcomes in adults with human immunodeficiency virus (HIV), according to findings from a new study.

From September 22, 2005, to August 6, 2015, the researchers evaluated 5927 patients with HIV who were treated for their condition at 6 US medical centers and underwent at least 2 assessments of depressive severity.
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Ultimately, patients who had depression throughout the entirety of follow-up were 37% more likely to miss appointments (RR 1.37) and 23% more likely to have a detectable viral load (RR 1.23) compared with those who did not have depression during follow-up. Furthermore, the rate of mortality was twice as high (HR 2.02) among patients with depression vs patients without depression.

Specifically, in this cohort, participants experienced a median percentage of days with depression (PDD) of 14%, missed 10,361 (18.8%) of 55,040 scheduled visits, demonstrated 6191 (21.8%) detectable viral loads, and had a mortality rate of 1.5 deaths per 100 person-years.

The researchers noted that each 25% increase in PDD was associated with 8% higher odds of missing a schedule appointment (risk ratio [RR] 1.08), 5% higher odds of having a detectable viral load (RR 1.05), and 19% higher odds of mortality (hazard ratio [HR] 1.19).

“Greater chronicity of depression increased the likelihood of failure at multiple points along the HIV care continuum,” the researchers concluded. “Even modest increases in the proportion of time spent with depression led to clinically meaningful increases in negative outcomes.”

“Clinic-level trials of protocols to promptly identify and appropriately treat depression among adults living with HIV should be conducted to understand the effect of such protocols on shortening the course and preventing the recurrence of depressive illness and improving clinical outcomes,” they added.

—Christina Vogt

Reference:

Pence BW, Mills JC, Bengtson AM, et al. Association of increased chronicity of depression with HIV appointment attendance, treatment failure, and mortality among HIV-infected adults in the United States [Published online February 21, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.4726.