Association between depression and HIV treatment outcomes in a US military population with HIV infection

Abstract

Background Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and subsequent inability to attain viral load (VL) suppression. We evaluated associations between depression, self-reported adherence, and longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with and without depression. Methods Male NHS participants with available ICD-9 data for mental health diagnoses, Center for Epidemiological Studies Depression (CES-D) measures, and self-reported adherence (SRA) were included. ART use was defined as ART initiation between 2006 and 2010, with follow-up through 2015. SRA was defined as taking 95% of ART doses and continuous ART was defined as longitudinal ART use with gaps < 30 days. Continuous VL suppression was defined as maintaining VLs < 200 c/mL on ART. To analyse the association between depression and HIV treatment outcomes, latent class analysis was used to create classes of depression trajectories: low depression (LD), recent onset depression (ROD) and high Depression (HD). Results Participants had a mean age of 32 (± 8.3) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). Overall, older participants at HIV diagnosis had greater odds of having 95% self-reported adherence (OR 1.06, 95% CI 1.02–1.12), and African Americans had lower odds (OR 0.41, 95% CI 0.22–0.76) compared to Caucasians (OR 1.49, 95% CI 0.52–4.28). However, there was no difference in SRA by depression trajectory. Participants with HD had an increased odds of taking ART continuously (OR 1.75, 95% CI 0.99–3.09), and those with ROD had significantly higher odds of virologic failure (OR 0.58, 95% CI 0.38–0.91). Conclusions Although there was no observed association between depression and SRA, participants with ROD had lower odds of attaining the HIV treatment goal of VL suppression. Continued efforts to identify and aggressively manage mental health disorders is important to success along the HIV care continuum.

Intersectional stigmas are associated with lower viral suppression rates and antiretroviral therapy adherence among women living with HIV

“…Additional studies are needed to explore potential mediators such as social support (or lack thereof), coping strategies, mental health, and substance use. In our study, WHIV who experienced HIV and poverty stigma were not less likely to be adherent to ART, but they might be at risk of depressive symptoms, which would ultimately interfere with ART adherence [8,38].…”

The Characteristics and HIV-Related Outcomes of People Living with Co-occurring HIV and Mental Health Conditions in the United States: A Systematic Review of Literature from 2016 to 2021

“…Over half of the studies (55%) reviewed focused on depressive symptoms or a depression diagnosis among PLWH. Almost one in four PLWH experienced moderate to severe symptoms of depression [ 21 , 22 ]. Although certain studies found no observed associations found between depression and self-reported adherence [ 21 ] or no direct association between depression and VLS [ 19 , 23 ].…”

Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial

“…Importantly, we have also found more than twice the risk of death in index participants with moderate or severe depression. The causal pathway of this association is described by multiple studies showing the negative impact of depression at each stage of HIV treatment continuum: care engagement [ 28 ], ART initiation and adherence [ 29 – 31 ], and viral suppression [ 32 , 33 ], resulting in higher mortality [ 34 – 36 ]. However, some studies reported an independent effect of depression on mortality, controlling for the effects of adherence [ 37 , 38 ] and clinical variables [ 35 , 39 ], potentially suggesting other mechanisms.…”