title: C-reactive protein and depression in persons with Human Immunodeficiency Virus infection: the Positive Living with HIV (POLH) Study.
abstract: BACKGROUND
  Human Immunodeficiency Virus (HIV) infection has been frequently associated with chronic inflammation as well as depression. C-reactive protein (CRP) is positively associated with depression in people without HIV infection. We tested the hypothesis of an independent relationship between CRP and depression in a cohort of HIV-positive people.
  
  
  METHODS
  A cross-sectional survey was conducted among 316 HIV-positive people (181 men and 135 women) aged 18-60years residing in the Kathmandu Valley, Nepal. The latex agglutination turbidimetric method was used to measure serum CRP concentrations and the Beck Depression Inventory (BDI)-I method was used to measure depression, with a cut off of ⩾20 indicating likely depression. The relationship between CRP concentrations and depression symptoms was assessed using both multiple linear regression analysis and multiple logistic regression analysis, with adjustment for potential socio-demographic, cardiovascular, life-style, and HIV-related clinical and treatment confounding factors.
  
  
  RESULTS
  Twenty-six percent participants (men: 23%; women: 29%) met criteria for depression. In multiple regression analysis, the authors observed a linear relation between serum CRP concentrations and BDI score (beta for 1 unit change in ln(CRP)=1.13, p=0.001) in HIV-positive participants. In a logistic regression analysis, participants with serum CRP levels>3mg/L had a 2.3-fold higher odds of depression symptoms compared to those with serum CRP level⩽3mg/L (p=0.005). In analyses stratified by sex, associations were stronger in men than in women. For example, CRP>3mg/L was associated with a 3.6-fold higher odds of depression in men (p=0.002), while in women the odds ratio was 1.7 (p=0.33).
  
  
  CONCLUSIONS
  We found a linear relationship between serum CRP concentrations and depression symptoms score in HIV-positive people, and evidence that risk of depression is elevated among HIV-positive men with a high level of inflammation (CRP>3mg/L). Further prospective study to confirm the role of inflammation in depression among HIV-positive people is warranted.
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Poudel-Tandukar
authors.affiliation: Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 409 Arnold House, 715 North Pleasant Street, Amherst, MA 01003-9304, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Bertone-Johnson
authors.affiliation: School of Community and Global Health, Claremont Graduate University, 675 West Foothill Boulevard, Suite 310, Claremont, CA 91711-3475, USA.
authors.forename: Paula H
authors.initials: PH
authors.lastname: Palmer
authors.affiliation: Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, 316 Arnold House, 715 North Pleasant Street, Amherst, MA 01003-9304, USA. Electronic address: krishna@schoolph.umass.edu.
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Poudel
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000097:blood* / Q000150:complications / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; Depression; HIV; Nepal