The onset of depression can lead to poorer adherence to HIV treatment, US investigators report in a study published in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The research also showed that a large proportion of HIV-positive patients have symptoms of depression.
In addition to depression, female sex, African American race, and poverty were associated with poorer adherence to HIV treatment.
High levels of adherence are needed to obtain the maximum benefit from HIV treatment, with research suggesting that the best results are seen in individuals who take at least 95% of their doses. Many patients, however, find it difficult to achieve this.
Earlier studies have shown that depression is one of the factors that can affect adherence to HIV treatment. But the research exploring this relationship has been limited by its cross sectional design. Furthermore, this earlier research did not explore the relationship between the onset of depression and adherence.
Investigators from the US Nutrition and Healthy Living Study therefore designed a study looking at the relationship between the onset of depression and adherence to HIV treatment over a period involving four clinic visits.
Validated scales were used to diagnose depression and adherence was assessed by patient report. Sub-optimal adherence was defined as adherence below 95% in the previous seven days.
The investigators also examined which other factors were associated with poorer adherence.
Patients were screened for depression at each clinic visit and were eligible for inclusion in the study if they were free from symptoms of depression at the first two study visits. A total of 225 patients were eligible for inclusion in the study.
Three-quarters were men, 40% were non-white, and most (89%) were high school graduates. Viral load was below 400 copies/ml at the end of the study in 63% of patients.
Of the 225 patients without depressive symptoms at the first two study visits, 51 (22%) had developed depressive symptoms by clinic visits three and four. Those developing depression were more likely to be women (37% vs 18%, p = 0.005), live in poverty (annual income below $10,000 per year, 58% vs 36%, p = 0.005), have more symptoms of HIV infection (p = 0.001), and have less social support (p = 0.0001).
Among the 177 patients assessed as being adherent to their HIV treatment at study visits one and two, 34% of those experiencing the onset of depression had sub-optimal adherence at the two subsequent study visits, compared to 19% of those without such symptoms (p = 0.05).
Statistical analysis that controlled for possible confounding factors showed that the onset of depression nearly doubled the risk of sub-optimal adherence (risk ratio [RR] =1.8; 95% confidence interval [CI]: 1.1-3.0). African American race was also a predictor of poorer adherence (RR = 1.9; 95% CI: 1.2-3.3).
“The relationship of depressive symptoms to [antiretroviral] adherence is dynamic rather than static”, write the investigators, “our finding that depression symptom onset is associated with a change to suboptimal adherence supports the need for further research to evaluate the impact of treatment for depression on adherence to highly active antiretroviral therapy.”
The investigators also believe their study “underscores the importance of ongoing screening for and attention to depression among women and men with HIV infection.”
Kacanek D et al. Incident depression symptoms are associated with poorer HAART adherence: a longitudinal analysis from the Nutrition for Healthy Living study. J Acquir Immune Defic Syndr (online edition), 2009.