Clinical importance of HIV and depressive symptoms among veterans with HIV infection.
OBJECTIVE
To compare the clinical importance (association with illness severity and survival) of depressive and HIV symptoms among veterans with HIV infection.


METHODS
Cross-sectional study; survival analysis.


METHODS
Infectious Disease Clinics at 3 VA Medical Centers.


METHODS
HIV-infected patients (N = 881) and their health care providers from June 1999 through July 2000.


RESULTS
Depressive symptoms were assessed using the 10-item Centers for Epidemiologic Studies Depression Scale (CES-D). Patient baseline survey included an HIV Symptom Index measuring the frequency and bother of 20 common symptoms. Providers were surveyed on patients' illness severity, and survival data were obtained from VA death records. Of 881 patients, 46% had significant depressive symptoms (CES-D >/=10). Increasing depression symptom severity was associated with increasing HIV symptom frequency (P <.001) and bother (P <.001). Multiple regression results revealed that having moderate or severe depressive symptoms was not associated with provider-reported illness severity or survival. However, HIV symptoms were significantly associated with provider-reported illness severity (P <.01) and survival (P =.05), after adjusting for moderate and severe depressive symptoms, CD4 cell count/mm3, viral load, age, race, and antiretroviral use.


CONCLUSIONS
Depression, while common in this sample, was not associated with illness severity or mortality after adjusting for HIV symptoms. HIV symptoms are associated with severity of illness and survival regardless of patients' severity of depressive symptoms. This suggests that equal medical consideration should be given to HIV symptoms presented by HIV-infected patients regardless of their depression status, rather than automatically attributing medical complaints to depression.
VA Pittsburgh Center for Health Equity Research and Promotion, the University of Pittsburgh Center for Research on Health Care, School of Medicine, Division of General Internal Medicine, Pittsburgh, PA 15240, USA. Amy.Kilbourne@med.va.gov
Amy M
AM
Kilbourne
Amy C
AC
Justice
Bruce L
BL
Rollman
Kathleen A
KA
McGinnis
Linda
L
Rabeneck
Sharon
S
Weissman
Susan
S
Smola
Richard
R
Schultz
Jeff
J
Whittle
Maria
M
Rodriguez-Barradas
D000328:Adult; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States; D014728:Veterans; D019562:Viral Load