Depression, Viral Load Associated in Patients with HIV

March 9, 2018

The point prevalence of depression among East African HIV AFRICOS study participants undergoing HIV care is 18% to 25%.

A new study has found that depression is strongly associated with East African patients with HIV who are not receiving care for the virus.

Results from the African Cohort Study (AFRICOS), a prospective, longitudinal trial spanning 11 different HIV care sites throughout Africa, examined 2335 patients with HIV in eastern region sites located in Kenya, Tanzania, and Uganda. Its impactful data on depressive symptoms in people with HIV were presented at the 25th Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, MA, this week.

Led by Susan M. Meffert, MD, MPH, of the University of California, San Francisco, researchers sought out the role of depression as a comorbidigy for people with HIV, and its association with non-adherence to antiretroviral therapy (ART). The team noted that psychosocial intervention in patients with HIV commonly focus on ART, but HIV outcomes such as viral load may also be associated with depression.

Using baseline data from AFRICOS participants undergoing HIV therapy at the time of analysis, researchers assessed the cross-sectional relationships between depression, ART adherence, HIV viral load, and cognition in patients. They assessed depressive symptoms using the revised Center for Epidemiologic Studies Depression Scale (CESD).

They then modeled patient self-reporting of complete and incomplete ART adherence over the past month with logistic regression, and modeled HIV viral load and individual CESD items with liner regression among participants undergoing ART for 6 or more months.

Researchers cited demographics, purchasing power, cognitive impairment, and ART adherence, among others, as covariates to the study results.

Results showed that the point prevalence of depression among East African HIV AFRICOS study participants undergoing HIV care is 18% to 25%. Depression was associated with decreased ART adherence in the observed participants, regardless of cognitive impairment (OR 039-0.88; P = 0.01). For participants undergoing ART for at least 6 months, depression was also associated with nearly twice the viral load count of non-depressed patients with HIV, independently of ART adherence and cognitive impairment (P = 0.00).

Within viral load metrics, 7 of the 9 distinguished depression symptom clusters were significantly associated with worse levels, regardless of ART adherence or cognition in participants to have undergone at least 6 months of ART.

Previous research into depressive symptoms in people with HIV has linked the symptoms to HIV viral load through neurocognition. Researchers can now connect the pathway between these 2 metrics with ART adherence rates.

Researchers also wrote the results imply that “comprehensive depression treatment is necessary to fully address the relationship between HIV viral load and depression.”

“Future research should include scalable, evidence-based depression treatment for people living with HIV, with assessment of impact on HIV viral load,” researchers wrote.

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