Psychological effects of HAART: a 2-year study.
OBJECTIVE
The objectives of this study were to evaluate the psychological consequences of combination antiretroviral treatment in terms of mood, hope, and life satisfaction in men with symptomatic human immunodeficiency virus (HIV) infection or acquired immune deficiency syndrome and to compare those whose health improved with those whose health did not improve.


METHODS
One hundred seventy-three HIV+ gay or bisexual men with symptomatic HIV illness (40% nonwhite) were evaluated semiannually in a university-affiliated research program between July 1995 and December 1997. The primary outcome measures were the Structured Clinical Interview for DSM-IV, Beck Depression Inventory, Endicott Quality of Life Enjoyment and Satisfaction Questionnaire, and Beck Hopelessness Scale.


RESULTS
Psychological distress in this sample was mild to moderate at baseline. During the first 2 years that highly active antiretroviral therapy became widely available, we observed a statistically significant but clinically modest reduction in distress in the sample as a whole, with significant covariates of CD4 cell count, HIV symptoms, and social support in a mixed-effects model. Rates of clinical depression declined. However, this generalized mental health improvement was not related to individual medical improvement of markers of HIV illness progression; those classified as improved were no more likely than those who remained unimproved to report greater declines in measures of distress and hopelessness. Number of self-reported physical symptoms were directly related to distress levels.


CONCLUSIONS
A cohort effect was observed, with overall psychological improvement. Physical symptoms were more strongly related to psychological distress than were laboratory markers. Consequently, those whose CD4 cell count and HIV RNA viral load reflected successful treatment were no more likely than others to be relieved of the psychological burdens of illness.
Rabkin
J G
JG
Department of Psychiatry, Weill College of Medicine, Cornell University, Ithaca, NY, USA. jgr1@Columbia.edu
Ferrando
S J
SJ
Lin
S H
SH
Sewell
M
M
McElhiney
M
M
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015704:CD4 Antigens / Q000276:immunology; D003863:Depression / Q000175:diagnosis* / Q000209:etiology*; D018450:Disease Progression; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012720:Severity of Illness Index; D012944:Social Support; D013001:Somatoform Disorders / Q000175:diagnosis / Q000209:etiology; D011795:Surveys and Questionnaires
D000998:Antiviral Agents; D015704:CD4 Antigens