Depression In HIV Patients Research Articles

Effects of Depression on HIV

Depression is a pressing issue in individuals living with HIV (PLWH), attracting the attention of epidemiologists and physicians. Approximately 39% of PLWH experience some level of depression associated with accelerated disease progression and poor health outcomes. Depression rates among PLWH range from 22% to 71%, yet it remains underdiagnosed in many cases. HIV infection has significant negative psychological effects due to its neurotropic nature, potentially leading to neuropathological changes in the brain’s grey matter and subsequent depression. Furthermore, depression is linked to increased healthcare utilization, decreased quality of life, and higher suicide rates in PLWH. It is also associated with poor adherence to antiretroviral therapy (ART), leading to immunological failure and increased HIV transmission risk. Therefore, effective management of depression is crucial for HIV patients. This literature review aimed to understand the impact of mental disorders, particularly depression, on HIV/AIDS. The methodology involved an extensive search of medical databases using specific keywords and inclusion criteria. The results revealed a disproportionately high level of depression in HIV patients, negatively affecting disease progression and quality of life. Biologically, HIV triggers inflammation and sickness behavior resembling depressive symptoms. Depression is associated with low CD4 cell counts, high viral loads, accelerated HIV-to-AIDS progression, and increased mortality risk. Consequently, integrating depression screening and psychological healthcare into regular HIV/AIDS care is essential to address the elevated prevalence rates of depression in PLWH and improve public health outcomes.

The risk of depression among racially diverse people living with HIV: the impact of HIV viral suppression

ABSTRACT Understanding the correlates of depression in HIV patients can help identify groups whose members are at increased risk for depression. We conducted a cross-sectional retrospective study among racially diverse, indigent patients living with HIV (PLWH) who were obtaining care in an urban safety-net hospital system and had completed a Patient Health Questionnaire-9 (PHQ-9) in 2014 or 2015. We collected demographics, HIV risk factors, HIV viral loads, CD4 counts, missed visits, and emergency department (ED) visits. Data from the Substance Abuse and Mental Illness Symptoms Screener (SAMISS) were abstracted. Missing data on substance use and CD4 cell counts were imputed to examine the odds of depression (PHQ-9 ≥ 10) by multivariable analysis for a complete case and sensitivity analysis. Stratified analysis by HIV viral suppression (VS) was used to determine the odds of depression among subgroups. Of the 5126 HIV patients (70.8% male,56.3% Black, 44.6% MSM, 6.0% IDU), 1271 (24.8%) experienced depression (PHQ ≥ 10). In a multivariable logistic model female gender, White race, injection drug use (IDU) or men who have sex with men (MSM) as an HIV risk factor, making ≥1 ED visit, having missed any HIV visit, having AIDS, and having a positive drug screen by SAMISS increased the odds for depression. Those who had achieved HIV VS or received efavirenz had lower odds of depression. Even among those with AIDS, those failing to achieve VS were at increased odds for depression, whereas those achieving VS were not. Moderate to severe depression is prevalent among PLWH. Among those with AIDS, HIV VS modifies the odds of depression.

Prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Dessie referral hospital, South Wollo, Ethiopia

IntroductionDepression is one of the common mental health disorders and predicted to be the second cause of the global health burden by the year 2020. Depression in HIV patients may lead to poor engagement to their HIV care which may finally result in poor treatment outcomes. Therefore, the aim of this study was to assess the prevalence of depression and associated factors among HIV/AIDS patients on ART at Dessie referral hospital.MethodsAn institution based cross-sectional study was conducted among 395 HIV positive adult patients on antiretroviral treatment from November to January 2019. The study participants were selected by using the systematic random sampling technique among patients who visited the antiretroviral (ART) clinic in the hospital and standardized Patients Health Questionnaire (PHQ-9) was used to measure depression. Descriptive statistics like percentage, median with interquartile range (IQR) was computed and presented in the form of text and table. Binary logistic regression model was fitted to identify factors associated with depression. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to identify factors associated with depression.ResultThe prevalence of depression was found to be 20% with (95% CI 16.2, 23.8). Age group of 25–34 years (AOR = 6.58, 95% CI 1.11, 38.9), widowed marital status (AOR = 7.05, 95% CI 2.32, 21.38), perceived stigma (AOR = 2.43, 95% CI 1.13, 5.21)], had opportunistic infections [AOR = 4.96, 95% CI (1.05, 23.34)], HIV non-disclosed HIV status (AOR = 6.34, 95% CI 1.34–29.65), poor and fair drug adherence (AOR = 7.1, 95% CI 2.06, 24.44), CD4 count ≤ 200 (AOR = 5.38, 95% CI 2.37–12.23) were factors significantly associated with depression.ConclusionThe magnitude of depression was relatively lower than the pooled estimates for Ethiopia. Perceived stigma, younger age, widowed, being symptomatic, fair and poor adherence, recent opportunistic infection, low CD4 count, and HIV status not disclosed were positively associated with depression. This finding suggests the integration of mental health care with antiretroviral therapy and the special emphasis ought to be given for those at higher risk of depression.

Comparison of Three Health-Related Quality of Life Instruments to Evaluate Symptoms of Depression in HIV Patients in Brazil

The evaluation of quality of life could be a useful indicator of depression in HIV patients. We compared the performance of three health-related quality of life (HRQoL) instruments for detecting depression. This nested case-control study included 200 HIV patients attended at an AIDS referral center. Depression was measured by Beck Depression Inventory (BDI). We accessed HRQoL by SF-36v2, HAT-QoL, and WHOQOL-HIV Bref. The depression diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curve analysis. SF-36v2 presented negative correlation with BDI score (- 0.72 to - 0.40), and HAT-QoL (- 0.66 to 0.05) and WHOQoL-HIV Bref (- 0.67 to 0.32) domains presented negative and positive correlations. Mental Health (r = - .71) and Mental Component Summary (r = - .72) showed high negative correlation with BDI. SF-36v2 showed excellent measure by the ROC curve analysis in four factors, and high correlation in Mental Health and MCS. Sf-36 may represent a useful tool for screening of depressive symptoms in HIV patients.

The Importance of the Family: A Longitudinal Study of the Predictors of Depression in HIV Patients in South Africa.

As a chronic illness, HIV/AIDS requires life-long treatment adherence and retention-and thus sufficient attention to the psychosocial dimensions of chronic disease care in order to produce favourable antiretroviral treatment (ART) outcomes in a sustainable manner. Given the high prevalence of depression in chronic HIV patients, there is a clear need for further research into the determinants of depression in this population. In order to comprehensively study the predictors of depressive symptoms in HIV patients on ART, the socio-ecological theory postulates to not only incorporate the dominant individual-level and the more recent community-level approaches, but also incorporate the intermediate, but crucial family-level approach. The present study aims to extend the current literature by simultaneously investigating the impact of a wide range individual-level, family-level and community-level determinants of depression in a sample of 435 patients enrolled in the Free State Province of South Africa public-sector ART program. Structural equation modeling is used to explore the relationships between both latent and manifest variables at two time points. Besides a number of individual-level correlates-namely education, internalized and external stigma, and avoidant and seeking social support coping styles-of depressive symptoms in HIV patients on ART, the study also revealed the important role of family functioning in predicting depression. While family attachment emerged as the only factor to continuously and negatively impact depression at both time points, the second dimension of family functioning, changeability, was the only factor to produce a negative cross-lagged effect on depression. The immediate and long-term impact of family functioning on depression draws attention to the role of family dynamics in the mental health of people living with HIV/AIDS. In addition to individual-level and community-based factors, future research activities should also incorporate the role of the family context in research into the mental health of HIV patients, as our results demonstrate that the familial context in which a person with HIV on ART resides is inextricably interconnected with his/her health outcomes.

Therapeutic effects of minocycline on mild-to-moderate depression in HIV patients: a double-blind, placebo-controlled, randomized trial.

Patients with the HIV infection are at high risk for developing depression. The aim of this study was to investigate the safety and efficacy of antidepressant effects of minocycline on HIV patients with depression. Forty-six HIV patients, with mild-to-moderate depression and a Hamilton Depression Rating Scale (HDRS) up to 18, participated in a parallel, randomized, double-blind, placebo-controlled trial and underwent 6 weeks of treatment with either minocycline (100 mg twice daily) or placebo in the same manner. Patients were assessed using HDRS at baseline and at weeks 3 and 6. The primary outcome measure was to evaluate the efficacy of minocycline in improving depressive symptoms. General linear model repeated measures showed significant effect for time × treatment interaction on the HDRS score during the trial course [F(2, 88)=7.50, P=0.001]. There was no significant difference between the two groups regarding adverse events. No serious adverse event was reported. The administration of 100 mg minocycline twice daily seems to be safe and effective in improving depressive symptoms in HIV/AIDS patients with mild-to-moderate depression.

Discrepancies between physician's perception of depression in HIV patients and self-reported CES-D-20 assessment: the DHIVA study

ABSTRACTDepression in HIV/AIDS patients affects adherence and disease progression and often goes unnoticed. DHIVA is a cross-sectional epidemiologic survey, investigating the prevalence of depression in people living with HIV through use of a validated self-administered scale (CES-D-20), as well and the degree of concordance between the physician's perception and patients' reports. A total of 690 HIV-infected patients attending 24 centers across Italy were enrolled. Concordance was calculated by K statistics. Association between depression and subject characteristics were evaluated through univariate and multivariate logistic models (OR and 95%CI). The prevalence of depressive symptoms was 48.8% from patient's questionnaires and 49.5% from physicians' reports, with a low/fair concordance (K = .38, p < .001). CES-D-20 found severe depression in 22.5% of the patients vs 4% identified by physicians. 135/155 (87%) of the severely depressed patients (according to CES-D-20) were considered as non or mildly/moderately depressed by physicians. Risk of severe depression was associated with unemployment (p < .001), previous depression (p < .001), treatment failure (p = .001), and former smoking status (p = .018). Depression is frequent in HIV-infected patients in the HAART era, with significant discrepancy between physician perception and the self-reported CES-D-20 results. Screening should be mandatory in all HIV patients.

A study on depression in people living with HIV/AIDS in South-West part of Uttar Pradesh, India

HIV/AIDS and depression are often thought to be interlinked. HIV positive cases may trigger symptoms of depression which, in turn, may result in risky sexual behavior and spread of HIV. Interviews were conducted in 104 patients of HIV/AIDS at the Anti-Retroviral Therapy (ART) Clinic of a teaching hospital in Uttar Pradesh (India) to study depression and examine its prevalence and association, if any, with some socio-demographic and clinical variables. The tools used to assess anxiety and depression and their severities were General Health Questionnaire (GHQ) 28 and Montgomery-Asberg Depression Rating Scale (MADRS) . The majority of patients were of age 35 years &amp; above (62%), males (67%), married (85%), Hindus (88%), literate (73.1%), unemployed (35%) and of upper-lower socio-economic status (52%). Significant association of depression was found with religion, occupation and socio-economic status. Depression and anxiety were also found to be significantly associated with each other. There was, however, no association of depression with respondents’ age, gender, marital status, education, habitat, income, duration of illness from HIV/AIDS and the CD4 count. The high prevalence rate (67.3%) of depression amongst HIV patients in our study may be taken as marker to alert Counsellors of country’s ART Clinics for possible risk of depression in HIV patients. The above findings however, should be interpreted in the light of the fact that a parallel control group in the study was not included, studied sample was not large enough and the tools used to study the subjects for depression and anxiety were not adequately standardized.South East Asia Journal of Public Health Vol.5(1) 2015: 12-17

HITIDES cost saving for depression in HIV patients

HITIDES cost saving for depression in HIV patients

Assessment on depressive status and the therapeutic effects of highly active antiretroviral therapy among anti-HIV-1(+) population

To assess the depressive status and its influence on Chinese HIV-1(+) population, and how it was influenced by highly active antiretroviral therapy (HAART) and the CD4(+) T cell count. Anti-HIV-1(+) patients (age between 18 and 65 years old) who had met the criteria to commence the anti-HIV treatment but had not yet started, were selected from the Beijing Ditan Hospital between March 2011 and June 2012. BDI-II (Beck Depression Inventory) and a self-designed questionnaire were used to evaluate the baseline and the status of 48 weeks post the HAART treatment. Statistically, t test and the Wilcoxon rank sum test were used to compare the BDI scores under different conditions and before/after the HAART. (1) Of 100 subjects: male to female ratio was 99:1; the average age was 31.37 ± 5.58 years; the average education background was of 13.13 ± 3.51 years; the unemployed percentage was 4%; time before being identified as anti-HIV-1(+) was 5.0 (1.0 - 21.0) months; the percentage being infected through homosexual contact was 83%. The baseline BDI score was 6.0 (3 - 10.25). (2) There was no significant difference (P > 0.05) in BDI score between those subjects having had education less or more than 12 years; the BDI score of patients whose anti-HIV-1(+) was significantly higher (P < 0.05) among those discovered within the past 6 months than those more than 6 months. The BDI score of patients whose baseline CD4(+) T cell count below 200 cells/µl was significantly higher (P < 0.05) than those with baseline CD4(+) T cell count greater than 200 cells/µl. The CD4(+) T cell count was significantly high (P < 0.001) after 48 weeks of anti-viral treatment, but the BDI score was not significantly different (P > 0.05). There was no significant change (P > 0.05) in the proportion of patients with different degrees of BDI score before and after 48 weeks of antiviral treatment. Depression in HIV patients was most overt in the first six months when they were aware of the infection. The degree of depression was more severe in patients with baseline CD4(+) T cell count less than 200 cells/µl with improvement of immunity after the HAART did not alleviate the level of depression.

Prevalence and Predictors of Major Depression in HIV-Infected Patients on Antiretroviral Therapy in Bamenda, a Semi-Urban Center in Cameroon

Recent blue-ribbon panel reports have concluded that HIV treatment programs in less wealthy countries must integrate mental health identification and treatment into normal HIV clinical care and that research on mental health and HIV in these settings should be a high priority. We assessed the epidemiology of depression in HIV patients on antiretroviral therapy in a small urban setting in Cameroon by administering a structured interview for depression to 400 patients consecutively attending the Bamenda Regional Hospital AIDS Treatment Center. One in five participants met lifetime criteria for MDD, and 7% had MDD within the prior year. Only 33% had ever spoken with a health professional about depression, and 12% reported ever having received depression treatment that was helpful or effective. Over 2/3 with past-year MDD had severe or very severe episodes. The number of prior depressive episodes and the number of HIV symptoms were the strongest predictors of past-year MDD. The prevalence of MDD in Cameroon is as high as that of other HIV-associated conditions, such as tuberculosis and Hepatitis B virus, whose care is incorporated into World Health Organization guidelines. The management of depression needs to be incorporated in HIV-care guidelines in Cameroon and other similar settings.

Early microstructural white matter changes in patients with HIV: A diffusion tensor imaging study

BackgroundPrevious studies have reported white matter (WM) brain alterations in asymptomatic patients with human immunodeficiency virus (HIV).MethodsWe compared diffusion tensor imaging (DTI) derived WM fractional anisotropy (FA) between HIV-patients with and without mild macroscopic brain lesions determined using standard magnetic resonance imaging (MRI). We furthermore investigated whether WM alterations co-occurred with neurocognitive deficits and depression. We performed structural MRI and DTI for 19 patients and 19 age-matched healthy controls. Regionally-specific WM integrity was investigated using voxel-based statistics of whole-brain FA maps and region-of-interest analysis. Each patient underwent laboratory and neuropsychological tests.ResultsStructural MRI revealed no lesions in twelve (HIV-MRN) and unspecific mild macrostructural lesions in seven patients (HIV-MRL). Both analyses revealed widespread FA-alterations in all patients. Patients with HIV-MRL had FA-alterations primarily adjacent to the observed lesions and, whilst reduced in extent, patients with HIV-MRN also exhibited FA-alterations in similar regions. Patients with evidence of depression showed FA-increase in the ventral tegmental area, pallidum and nucleus accumbens in both hemispheres, and patients with evidence of HIV-associated neurocognitive disorder showed widespread FA-reduction.ConclusionThese results show that patients with HIV-MRN have evidence of FA-alterations in similar regions that are lesioned in HIV-MRL patients, suggesting common neuropathological processes. Furthermore, they suggest a biological rather than a reactive origin of depression in HIV-patients.

Falling through the cracks

Depression is the most common mental health disorder among HIV patients, affecting 20–30% of those engaged in HIV medical care.1 In addition to being a serious, costly, and potentially fatal medical condition in its own right, depression poses challenging barriers to effective medical care at multiple points along the continuum of HIV medical care engagement and treatment,2 or what has become known as the “HIV treatment cascade.”3 The HIV treatment continuum shows that for an HIV-infected individual to achieve virologic suppression, the individual must be aware of his or her diagnosis, engage in HIV medical care, remain in care, start antiretroviral therapy (ART), and adhere to ART. Thus high population-level success rates in testing, linking and retaining in care, initiating ART, and maximizing adherence are essential to maximally reduce “community viral load.”4 However, with substantial attrition at each step along the HIV treatment continuum, a recent analysis estimated that only 19% of HIV-infected individuals in the US currently have suppressed virus.2 Attrition along the steps of the HIV treatment continuum is related to many factors, but in particular is strongly predicted by depression. Mounting evidence suggests that effectively treating depression in HIV patients may have benefits for their HIV treatment retention, ART adherence, and virologic suppression, and therefore for community viral load.5,6 However, the response to depression in HIV patients suffers from its own “treatment cascade.” Depression in HIV patients, while highly prevalent, is widely unrecognized.7 When clinically recognized, the condition often goes untreated.8 When treated, providers’ adherence to best-practices guidelines about dosing, duration, and monitoring of antidepressants is low, meaning that many patients fail to receive an adequate treatment course and therefore fail to benefit from treatment.9

Depression in HIV patients is associated with low adherence: a cross-sectional study among HIV patients in Denmark

Purpose of the study Depression is a common co-morbidity to HIV. International studies suggest that between 20–37% of HIV-positives may have a diagnosable depression. The current estimates may be underestimated as there is evidence that depression may be underdiagnosed. There are no studies on the number of Danish HIV-positives who have or have had a diagnosable depression. Our aim was to investigate the prevalence of depression among HIV-patients in an outpatient clinic in Denmark.

A Telephone-Based Intervention for Depression in HIV Patients: Negative Results from a Randomized Clinical Trial

To determine if a telephone support behavioral intervention improves depressive symptoms among HIV positive outpatients, we enrolled 177 persons with Beck Depression Inventory (BDI) scores scores of >/=10. Participants were randomized to receive up to 12 scheduled psycho-educational calls over 6 months or to an assessment-only control condition. Co-enrolled informal caregivers of HIV patients received the same telephone intervention in parallel. Among the 160 (90.4%) participants who were re-interviewed at 6 months, 56% were male, and 41% were Caucasian, with a mean baseline BDI score of 22.7. Overall, participants' mean BDI scores improved 5.3 points from baseline, but intervention group differences on depression outcomes including 50% or greater reduction in BDI scores and depression remission were not statistically significant. In the full cohort, men were significantly more likely to improve than women. We conclude that a psycho-educational telephone support intervention did not reduce depressive symptoms for HIV patients more than an assessment-only control condition.