title: The effect of depressive symptoms at ART initiation on HIV clinical progression and mortality: implications in clinical practice.
abstract: BACKGROUND
  Depression is common in HIV-infected patients receiving antiretroviral therapy. However, longitudinal studies addressing the role that depression might play in HIV clinical progression and mortality remain rare. This is especially true for those studies that also consider the possible confounding influence of patient's adherence to treatment.
  
  
  METHODS
  The ANRS CO-8 APROCO-COPILOTE cohort study enrolled 1,281 individuals at the initiation of a protease-inhibitor-containing regimen between 1997 and 1999. Adherence, depressive symptoms and other psychosocial factors were measured using self-administered questionnaires. Predictors of progression to AIDS or death were studied using Cox models.
  
  
  RESULTS
  Out of 1,028 individuals eligible for the present analysis, 92 individuals either died or had an AIDS-defining event during a median follow up of 54 months. At baseline, 377 individuals (41%) reported depressive symptoms and 124 (12%) reported non-adherence at month 4. Depressive symptoms at baseline were associated with progression (hazard ratio [HR] 2.1; P = 0.001). Despite the association between depressive symptoms and nonadherence, depressive symptoms remained a predictor of clinical progression (adjusted HR [aHR] [95% confidence interval (CI)] 1.6 [1.0-2.5]) after adjustment for several factors: initial non-adherence (aHR [95% CI] 2.0 [1.1-3.6]), having a steady partner (aHR [95% CI] 0.5 [0.3-0.7]), older age (aHR [95% CI] 1.40 [1.12-1.74] per 10-year increment), HIV clinical stage C (aHR [95% CI] 2.5 [1.6-4.0]), plasma HIV RNA > or = 100,000 copies/ml (aHR [95% CI] 1.7 [1.1-2.87]) and more than 8 years since HIV diagnosis (aHR [95% CI] 1.8 [1.1-2.8]).
  
  
  CONCLUSIONS
  Depressive symptoms and non-adherence are independent predictors of HIV clinical progression and mortality. Screening and appropriate treatment of depressive symptoms at antiretroviral treatment initiation should be included in the standard care of HIV-infected patients.
authors.affiliation: INSERM U379, Marseilles, France. villes@marseille.inserm.fr
authors.forename: Virginie
authors.initials: V
authors.lastname: Villes
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lewden
authors.forename: Christian
authors.initials: C
authors.lastname: Perronne
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Besnier
authors.forename: Michel
authors.initials: M
authors.lastname: Garré
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
authors.forename: Maria Patrizia
authors.initials: MP
authors.lastname: Carrieri
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moings
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D003863:Depression / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology* / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D011795:Surveys and Questionnaires