The effect of depressive symptoms at ART initiation on HIV clinical progression and mortality: implications in clinical practice.
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.
Villes
Virginie
V
INSERM U379, Marseilles, France. villes@marseille.inserm.fr
Spire
Bruno
B
Lewden
Charlotte
C
Perronne
Christian
C
Besnier
Jean-Marc
JM
Garré
Michel
M
Chêne
Geneviève
G
Leport
Catherine
C
Carrieri
Maria Patrizia
MP
Le Moings
Vincent
V
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