HIV-positive injecting drug users who were psychologically distressed progressed more quickly to AIDS, according to a US study published in the 1st April 2003 edition of the Journal of Immune Deficiency Syndromes.
The link between depression and HIV disease progression has long been debated, although a US study reported on aidsmap last year found that depressed women were less likely to access treatment.
In this study, investigators from Johns Hopkins University looked at the association between psychological distress and progression to AIDS over two years.
Patients enrolled in the ALIVE study (AIDS Link to Intravenous Experiences) were recruited to the study. A total of 451 HIV-positive, but AIDS free patients were eligible for the study between 1988 and 1999. At six monthly appointments patients had CD4 cell counts and viral load tests performed, were asked to report symptoms suggesting HIV disease progression such as oral thrush, and were asked to complete an eleven item questionnaire designed to assess psychological distress.
Psychological distress was diagnosed in 106 patients at baseline. Patients with CD4 counts below 200 cells/mm3 and women were statistically more likely to report psychological distress at enrolment.
Over the two years of the study 32 cases of AIDS were diagnosed. Distress was present in 43.7% of these patients, whereas only 22% of non-AIDS patients were distressed.
Lower baseline CD4 cell count, high viral load, and oral thrush were associated with distress on univariate analysis. However, even when these were controlled for, distress remained an independent predictor for the development of AIDS within two years.
The development of oral thrush within two years, a indicator of HIV disease progression was also found to be significantly associated with distress.
However, investigators were unable to find an independent link between psychological distress and death within two years.
The investigators comment that “the major finding of this study was that psychological distress was significantly associated with more rapid onset of AIDS among [injecting drug users] over a two year follow-up when controlling for CD4 cell count, HIV viral load and oral thrush.” They add “distress may precede the decline in immune function seen in HIV infection” and should be though of as clinically significant in HIV-positive injecting drug users.
Further information on this website
Depressed women less likely to access treatment - News story
US study finds poor adherence, depression, drug use and unprotected sex linked - News story
Depression - Overview
Mental health and HIV - Special edition of ATU (PDF)
Golub ET et al. Psychological distress and progression to AIDS in a cohort of injection drug users. JAIDS 32: 429-434, 2003.