title: Poor CD4 count is a predictor of untreated depression in human immunodeficiency virus-positive African-Americans.
abstract: OBJECTIVE
  To determine if efforts to improve antiretroviral therapy (ART) adherence minimizes the negative impact of depression on human immunodeficiency virus (HIV) outcomes.
  
  
  METHODS
  A cross-sectional study of a clinic-based cohort of 158 HIV seropositive (HIV+) African Americans screened for major depressive disorder (MDD) in 2012. CD4 T lymphocyte (CD4+) counts were obtained from these individuals. Self-report on adherence to ART was determined from questionnaire administered during clinic visits. The primary outcome measure was conditional odds of having a poorer CD4+ count (< 350 cells/mm(3)). Association between CD4+ count and antidepressant-treated or untreated MDD subjects was examined controlling for self-reported adherence and other potential confounders.
  
  
  RESULTS
  Out of 147 individuals with available CD4+ T lymphocyte data, 31% hadCD4+ count < 350 cells/mm(3) and 28% reported poor ART adherence. As expected the group with > 350 cells/mm(3) CD4+ T lymphocyte endorsed significantly greater ART adherence compared to the group with < 350 cells/mm(3) CD4+ T lymphocyte count (P < 0.004). Prevalence of MDD was 39.5% and 66% of individuals with MDD took antidepressants. Poor CD4+ T lymphocyte count was associated with poor ART adherence and MDD. Adjusting for ART adherence, age, sex and education, which were potential confounders, the association between MDD and poor CD4+ T lymphocyte remained significant only in the untreated MDD group.
  
  
  CONCLUSIONS
  Therefore, CD4+ count could be a clinical marker of untreated depression in HIV+. Also, mental health care may be relevant to primary care of HIV+ patients.
authors.affiliation: Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
authors.forename: Sasraku
authors.initials: S
authors.lastname: Amanor-Boadu
authors.affiliation: Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
authors.forename: MariaMananita S
authors.initials: MS
authors.lastname: Hipolito
authors.affiliation: Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
authors.forename: Narayan
authors.initials: N
authors.lastname: Rai
authors.affiliation: Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
authors.forename: Charlee K
authors.initials: CK
authors.lastname: McLean
authors.affiliation: Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
authors.forename: Kyla
authors.initials: K
authors.lastname: Flanagan
authors.affiliation: Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
authors.forename: Flora T
authors.initials: FT
authors.lastname: Hamilton
authors.affiliation: Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
authors.forename: Valerie
authors.initials: V
authors.lastname: Oji
authors.affiliation: Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
authors.forename: Sharon F
authors.initials: SF
authors.lastname: Lambert
authors.affiliation: Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
authors.forename: Huynh Nhu
authors.initials: HN
authors.lastname: Le
authors.affiliation: Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
authors.forename: Suad
authors.initials: S
authors.lastname: Kapetanovic
authors.affiliation: Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.
authors.forename: Evaristus A
authors.initials: EA
authors.lastname: Nwulia
keywords: African Americans; Antiretroviral Therapy; CD4 T lymphocyte count; Depression; Human immunodeficiency virus positive