Antidepressants improve ART adherence and quality of life in HIV-positive men with depression

HIV-positive men with depression who do not take antidepressants are four times as likely to have poor adherence to antiretroviral therapy (ART), Dr Yung-Feng Yen and colleagues report in PLoS ONE. The study also found that those without antidepressants had worse psychological, social, and environmental health-related quality of life compared to those using antidepressants. 

Depression is common in people with HIV and has been associated with HIV disease progression and poor health outcomes. However, the adequate diagnosis and treatment of depression in people with HIV is often neglected in healthcare facilities. Since the UNAIDS ‘fourth 90’ target requires that 90% of people with viral load suppression should have a good health-related quality of life, this study investigated the association of depression and antidepressants with ART adherence and health-related quality of life in HIV-positive men who have sex with men.

The research was conducted in Taiwan, where, at the end of 2019, 65% of people with HIV were men who have sex with men.

The investigators recruited 557 HIV-positive men who have sex with men from the Taipei City Hospital HIV clinic, which is the largest HIV care centre in Taiwan. Participants had a mean age of 38 years, all were receiving ART, and were interviewed about their treatment adherence and health-related quality of life. The researchers also collected viral load and CD4 count data from the patients’ medical charts.

To measure adherence to ART, the Medication Adherence Report Scale (MARS-5) was used. Nonadherence was defined as a MARS-5 score of less than 23 (out of 25). The participants’ health-related quality of life was evaluated using the Taiwanese version of the World Health Organization Quality of Life questionnaire. The questionnaire measured four domains: physical capacity, psychological well-being, social relationships, and environmental health. All items were rated on a five-point scale with a higher score showing better health-related quality of life.

Out of the 557 participants, 14% reported depression. Participants with depression were more likely to report nonadherence to ART (22%) compared to non-depressed participants (11%). They were also more likely to have a lower income (26% vs 9%), smoke (56% vs 40%), use recreational drugs (17% vs 6%)and have gonorrhoea (18% vs 10%).

However, among those with depression, 55 were on antidepressants and 23 were not. After controlling for demographic characteristics, the researchers found that poor adherence to ART was significantly associated with untreated depression; participants without antidepressants were four times as likely to have poor adherence (adjusted odds ratio = 4.02; 95% confidence interval: 1.44–11.21). For those taking antidepressants, nonadherence was not significant. Those without antidepressants also had worse psychological, social, and environmental health-related quality of life compared to those on antidepressants.

“To achieve UNAIDS HIV testing and treatment targets, our study suggests that it is imperative to screen for depressive symptoms in people with HIV and to provide antidepressant therapy for those with depression in order to improve their adherence to ART and their health-related quality of life”, the researchers conclude.