Abstract
Background: Depression is common in HIV-infected patients and may affect response to Antiretroviral Therapy (ART). We analyzed anonymized data from the DR’s major non-governmental ART clinics to estimate the prevalence of and characteristics associated with Clinically-significant Depressive Symptomatology (CSDS) in Dominican Republic (DR) ART patients, and its impact on response to ART. Methods: We performed a cross-sectional analysis of data obtained by questionnaires screening for CSDS, ART adherence, and food insecurity in a convenience sample of non-acutely ill ART patients seen in the collaborating clinics in 20 workdays in May-June 2013. Demographic characteristics and most recent CD4+ T-lymphocyte counts and plasma HIV-RNA levels (“viral loads”) were obtained by medical record review. Factors associated with CSDS and poor ART response were identified by comparing prevalence of CSDS and ART failure by patient characteristics. Results: Of 205 patients, 61 (29.8%) met criteria for CSDS. CSDS prevalence was higher among residents in bateyes (sugarcane plantation-worker barracks) (100%) than in those residing elsewhere (26.9%; p<0.001) and in patients reporting food insecurity (52.2%) than in those denying it (18.8%); p<0.001). Patients taking ART for less than 36 months were more likely to have CSDS (38.6%) than those with longer ART duration (23.8%; p=0.02). Proportions of patients with viral suppression were higher in: females (64.9%) than males (48.8%; p=0.02); patients with ART for over 36 months (66.0%) versus those with shorter ART duration (47.0%; p=0.009); patients reporting perfect (63.4%) versus imperfect adherence (42.3%; p=0.009), and; patients without CSDS (64.0%) versus those with CSDS (40.0%; p=0.002). When controlled for perfect ART adherence, ART duration, and gender in logistic regression, CSDS was independently associated with decreased likelihood of viral suppression (OR=0.4; 95% confidence interval=[0.2-0.8]; p=0.006). Conclusions: CSDS is associated with ART failure even when controlled for adherence. Depression treatment may improve ART response and patients’ quality of life.
Highlights
Over 75% of the estimated 250,000 HIV-infected persons in the Caribbean, the second most HIV-affected region in the world after Sub-Saharan Africa, live in Hispaniola, the island shared by Haiti (60%) and the Dominican Republic (DR) (18%) [1]
We explored patterns of adherence and response to Antiretroviral Therapy (ART) in DR patients, the scope and determinants of clinically-significant depressive symptomatology (CSDS) in this population, and Clinically-significant Depressive Symptomatology (CSDS)’ impact directly on viral and immunologic response
CSDS and food insecurity determinations were made based on responses to the Center for Epidemiologic Studies Depression Scale-20 (CESD-20) [34] and food insecurity two-question screening questionnaire [35] in interviews administered by clinic staff
Summary
Over 75% of the estimated 250,000 HIV-infected persons in the Caribbean, the second most HIV-affected region in the world after Sub-Saharan Africa, live in Hispaniola, the island shared by Haiti (60%) and the Dominican Republic (DR) (18%) [1]. As in other low and middle-income countries advances associated with ART scale-up in the DR and the psychosocial challenges faced there have increased interest in improvement of other neglected healthcare services, including mental health [2,3,4,5,6,7,8,9]. Depression is common in persons with HIV infection [12,13,14,15]. Depression is common in HIV-infected patients and may affect response to Antiretroviral Therapy (ART). We analyzed anonymized data from the DR’s major non-governmental ART clinics to estimate the prevalence of and characteristics associated with Clinically-significant Depressive Symptomatology (CSDS) in Dominican Republic (DR) ART patients, and its impact on response to ART
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