Reductions in HIV risk behaviors among depressed drug injectors.
OBJECTIVE
To determine if, by reducing depressive symptoms, combined psychotherapy and pharmacotherapy reduces HIV drug risk behavior compared to an assessment-only condition for active drug injectors over 9 months.


METHODS
Randomized controlled trial.


METHODS
Outpatient academic research office.


METHODS
Active injection drug users with a DSM-IV diagnosis of major depression, dysthymia, substance-induced mood disorder with depressive features persisting for at least 3 months, or major depression plus dysthymia. In addition, participants had a Hamilton Rating Scale for Depression (MHRSD) score > 13.


METHODS
Psychotherapy (8 sessions of cognitive behavioral therapy) plus antidepressant pharmacotherapy over 3 months.


METHODS
HIV Risk Assessment Battery (RAB) drug scale scores measured at three, six and nine months, and depression remission (MHRSD score < or = 8).


RESULTS
Participants (n= 109) were 64% male, 82% Caucasian, with a mean baseline MHRSD score of 20.7. Depression subtypes included major depression only (63%), substance-induced depression (17%), and double-depression (17%). Overall, study retention at nine months was 89%. Reported HIV drug risk scores decreased sharply over the first 3 months and continued to decline throughout the follow-up period. Between group differences were not significant in the intention-to-treat analysis. However, highly adherent participants had significantly lower HIV drug risk scores at 3 months (p<05), but not 6 and 9 months. Depression remission was significantly associated with lower HIV drug risk scores at follow-ups.


CONCLUSIONS
Combined psychotherapy and pharmacotherapy did not produce a significant reduction in HIV drug risk beyond that seen in an assessment-only control group. The greatest declines in HIV drug risk were found in participants with high protocol adherence and those with depression remission.
Stein
Michael D
MD
Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA. mstein@lifespan.org
Anderson
Bradley J
BJ
Solomon
David A
DA
Herman
Debra S
DS
Ramsey
Susan E
SE
Brown
Richard A
RA
Miller
Ivan W
IW
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D012237:Rhode Island / Q000453:epidemiology; D040242:Risk Reduction Behavior; D018709:Statistics, Nonparametric; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*
D000928:Antidepressive Agents