Abstract

ObjectivesWe studied the incidence and prevalence of, and co-factors for depression in the Swiss HIV Cohort Study.MethodsDepression-specific items were introduced in 2010 and prospectively collected at semiannual cohort visits. Clinical, laboratory and behavioral co-factors of incident depression among participants free of depression at the first two visits in 2010 or thereafter were analyzed with Poisson regression. Cumulative prevalence of depression at the last visit was analyzed with logistic regression.ResultsAmong 4,422 participants without a history of psychiatric disorders or depression at baseline, 360 developed depression during 9,348 person-years (PY) of follow-up, resulting in an incidence rate of 3.9 per 100 PY (95% confidence interval (CI) 3.5–4.3). Cumulative prevalence of depression during follow-up was recorded for 1,937/6,756 (28.7%) participants. Incidence and cumulative prevalence were higher in injection drug users (IDU) and women. Older age, preserved work ability and higher physical activity were associated with less depression episodes. Mortality (0.96 per 100 PY, 95% CI 0.83–1.11) based upon 193 deaths over 20,102 PY was higher among male IDU (2.34, 1.78–3.09), female IDU (2.33, 1.59–3.39) and white heterosexual men (1.32, 0.94–1.84) compared to white heterosexual women and homosexual men (0.53, 0.29–0.95; and 0.71, 0.55–0.92). Compared to participants free of depression, mortality was slightly elevated among participants with a history of depression (1.17, 0.94–1.45 vs. 0.86, 0.71–1.03, P = 0.033). Suicides (n = 18) did not differ between HIV transmission groups (P = 0.50), but were more frequent among participants with a prior diagnosis of depression (0.18 per 100 PY, 95%CI 0.10–0.31; vs. 0.04, 0.02–0.10; P = 0.003).ConclusionsDepression is a frequent co-morbidity among HIV-infected persons, and thus an important focus of care.

Highlights

  • Depressive disorders are frequent among HIV-positive persons

  • Incidence and cumulative prevalence were higher in injection drug users (IDU) and women

  • Mortality (0.96 per 100 PY, 95% CI 0.83–1.11) based upon 193 deaths over 20,102 PY was higher among male IDU (2.34, 1.78–3.09), female IDU

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Summary

Introduction

Depressive disorders are frequent among HIV-positive persons. Studies from the period before the availability of effective antiretroviral treatment (ART) reported proportions as high as 48% [1, 2], which was nearly two times higher than in HIV-negative comparison groups as shown in a meta-analysis of ten studies by Ciesla et al [3]. The relative contribution of psychosocial, behavioral (including illicit and recreational drug use), and somatic (i.e., virus and ART-related) factors in the pathogenesis of depression in HIV-positive persons are not well defined. There have been only few studies of risk factors for and outcomes of depressive disorders since relatively well tolerated and easy to take combination ART, including once daily single tablet regimens, became available. Because populations studied were heterogeneous with regards to ethnicity, migration status, and non-injecting or injecting drug use, gender differences may have been masked or confounded

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