Impact of Depression and Anxiety on Initiation of Antiretroviral Therapy Among Men Who Have Sex with Men with Newly Diagnosed HIV Infections in China.
Depression and anxiety are common among persons recently diagnosed with HIV infection. We examined whether depression or anxiety was associated with delayed initiation of antiretroviral therapy (ART) among a prospective cohort of Chinese men who have sex with men (MSM) who were newly diagnosed with HIV. The Hospital Anxiety and Depression Scale (HADS) was used for measuring depression and anxiety, with scores of 0-7, 8-10, and 11-21 representing normal, borderline, and likely, respectively. ART initiation information was extracted from the National ART Database. Cox regression was performed to assess associations between HADS scores and the time to ART initiation. Of 364 eligible participants enrolling in the cohort within a median of 11 days after HIV diagnosis, 62% initiated ART during the 12-month follow-up period. The baseline prevalence for likely/borderline depression was 36%, and likely/borderline anxiety was 42%. In adjusted analyses, compared with a depression score of 0, the likelihood of starting ART was 1.82 [95% confidence interval (CI): 1.38-2.41], 3.11 (95% CI: 1.82-5.30), and 2.53 (95% CI: 1.48-4.32) times higher for depression scores of 3, 9, and 13, respectively. A similar pattern was observed for the anxiety score. In contrast to our hypothesis, both depression and anxiety were associated with earlier ART initiation among Chinese MSM with newly diagnosed HIV. We speculate that individuals who are more concerned about their new HIV diagnosis may be more likely to seek HIV care and follow a doctor's advice. The effects of depression or anxiety on ART initiation likely differ in varying subgroups and by symptom severity.
1 Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine , Nashville, Tennessee.
Jun
J
Tao
1 Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine , Nashville, Tennessee.|2 Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.|3 Department of Pediatrics, Vanderbilt University School of Medicine , Nashville, Tennessee.
Sten H
SH
Vermund
4 Beijing Center for Disease Control and Prevention , Beijing, China .
Hongyan
H
Lu
5 State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC) , Beijing, China .
Yuhua
Y
Ruan
6 Department of Biostatistics, Vanderbilt University School of Medicine , Nashville, Tennessee.
Bryan E
BE
Shepherd
1 Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine , Nashville, Tennessee.|2 Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.
Aaron M
AM
Kipp
7 Department of Health Behavior and Health Education, University of Michigan , Ann Arbor, Michigan.
K Rivet
KR
Amico
8 Xicheng District Center for Disease Control and Prevention , Beijing, China .
Xiangjun
X
Zhang
5 State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC) , Beijing, China .
Yiming
Y
Shao
1 Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine , Nashville, Tennessee.|2 Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.
Han-Zhu
HZ
Qian
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods / Q000523:psychology*; D001007:Anxiety / Q000523:psychology*; D018791:CD4 Lymphocyte Count; D002681:China / Q000453:epidemiology; D003863:Depression / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012959:Socioeconomic Factors
China; antiretroviral therapy; anxiety; depression; men who have sex with men; newly diagnosed HIV infections