Role of Depression, Stress, and Trauma in HIV Disease Progression

Abstract

Despite advances in HIV treatment, there continues to be great variability in the progression of this disease. This paper reviews the evidence that depression, stressful life events, and trauma account for some of the variation in HIV disease course. Longitudinal studies both before and after the advent of highly active antiretroviral therapies (HAART) are reviewed. To ensure a complete review, PubMed was searched for all English language articles from January 1990 to July 2007. We found substantial and consistent evidence that chronic depression, stressful events, and trauma may negatively affect HIV disease progression in terms of decreases in CD4 T lymphocytes, increases in viral load, and greater risk for clinical decline and mortality. More research is warranted to investigate biological and behavioral mediators of these psychoimmune relationships, and the types of interventions that might mitigate the negative health impact of chronic depression and trauma. Given the high rates of depression and past trauma in persons living with HIV/AIDS, it is important for healthcare providers to address these problems as part of standard HIV care.

Routine Screening for Depression: Identifying a Challenge for Successful HIV Care

“…5,16,32 It is well documented that individuals with HIV have higher rates of depression than individuals without HIV. 3,8,31 The relationship revealed in this study that depression may have an impact on virologic suppression is considerable.…”

“…[4][5][6][7]8,10 The impact of depression on immune function is not well defined, yet significant negative associations have been reported regarding increased risk for substance use disorders, inconsistent use of condoms, nonadherence to HAART and routine medical care. [9][10][11][12][13][14][15][16] African Americans and women have been identified as groups who often have unrecognized or untreated depressive symptoms that may impact HIV-related health outcomes. [17][18][19][20][21][22] Individual interventions have been developed to address these negative mood disorders among HIV-infected populations and have been shown to be successful.…”

An evaluation of quality of life and its determinants among people living with HIV/AIDS from Southern Brazil

“…Reis et al 37 highlighted that psychopathological symptoms negatively affect quality of life and adherence to antiretroviral treatment. Moreover, the literature reports that increased levels of stress and depression accelerate the deterioration of the immune system and disease progression 38 .…”

Translation of a comprehensive health behavior intervention for women living with HIV: the SMART/EST Women's Program

“…Translation of behavioral interventions for people living with HIV/AIDS (PLWHAs) that addresses multiple risk behaviors is especially appropriate, as PLWHAs have been identified as being at increased risk of comorbid health conditions, such as cardiovascular and pulmonary diseases, depression, diabetes, and addiction [3,4]. In addition, psychiatric disorders have also been associated with decrements in essential health behaviors for PLWHAs (e.g., antiretroviral medication adherence [5][6][7][8][9] and medical appointment attendance [10,11]) and with poorer overall mental health and quality of life [12,13].…”