HIV Clinical Outcomes in the United States Negatively Influenced by Depression

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Depression was associated with an increased risk for higher mortality rates and missing HIV primary care appointments.
Depression was associated with an increased risk for higher mortality rates and missing HIV primary care appointments.

Moderate to severe levels of depression are associated with reduced primary care appointment attendance, greater treatment failure, and increased mortality in patients living with HIV, according to an observational cohort study published in JAMA Psychiatry.

The investigators observed a total of 5927 patients infected with HIV who were receiving care between 2005 and 2015 in the United States. Patients with ≥2 depressive severity evaluations, as assessed by the Patient Health Questionnaire-9, were included in the final analysis. The investigators examined depressive severity measures and their associations with missed HIV primary care visits, detectable HIV RNA viral load (≥75 copies/mL), and all-cause mortality outcomes.

Overall, the median percentage of days with depression in this cohort was 14% (interquartile range, 0% to 48%) during the 10,767 person-years of follow-up. Also, approximately 18.8% of scheduled HIV primary care visits were missed and 21.8% of viral loads were detectable. During follow-up, the mortality rate reached 1.5 deaths per 100 person-years.

The investigators also found that with an approximately 25% increase in the percentage of days with depression, there was an associated 5% increase in the risk for a detectable viral load (risk ratio [RR], 1.05; 95% CI, 1.01-1.09), 8% risk increase for missing a scheduled primary care appointment (RR, 1.08; 95% CI, 1.05-1.11), and 19% increase in mortality (hazard ratio [HR], 1.19; 95% CI, 1.05-1.36).

In addition, patients with depression during the entire follow-up period had a 23% increased risk of a detectable viral load (RR, 1.23; 95% CI, 1.06-1.43), 37% increased risk of missing appointments (RR, 1.37; 95% CI, 1.22-1.53), and a twice as high mortality rate (HR, 2.02; 95% CI, 1.20-3.42) compared with patients without depression.

Although the study sample was created from patients attending 6 geographically dispersed US academic medical centers, the investigators suggest that generalizability of the findings may be difficult for smaller or non-specialist care centers.

“Shortening the duration of depressive episodes (eg, through integration of improved screening and evidence-based depression treatment into HIV care) may have important HIV-related benefits,” concluded the investigators.

Reference

Pence BW, Mills JC, Bengtson AM, et al. Association of increased chronicity of depression with HIV appointment attendance, treatment failure, and mortality among HIV-infected adults in the United States [published online February 21, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.4726

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