Treating Depression May Lead to Better HIV Outcomes

Patients with HIV often develop depression related to their diagnosis due to multiple factors. Although treatment is recommended for patients with depression, the reality is that many individuals do not seek the proper therapy.

A study recently published by JAMA Psychiatry found a link between the length of time experiencing depression and missing medical appointments, higher mortality rates, and treatment failure among patients with HIV.

“A number of studies have found that people living with HIV who also have depression experience worse health outcomes than those without depression,” said lead author Brian W. Pence, PhD. “Almost all of this literature, though, puts people in either a ‘depressed’ bin or a ‘not depressed’ bin, even though we know there is a lot of variation in the severity, duration and recurrence of depression over time.”

To determine the relationship between time spent depressed and HIV care outcomes, the authors analyzed 5927 HIV-positive adults administered treatment across 6 different medical centers. Measures such as appointment attendance, treatment failure rate, and mortality rate were examined.

Patients were tasked with completing multiple depressive severity assessments, which were translated into a measurement of percent of days with depression (PDD).

The authors discovered that patients spent a median of 14% of their days with depression, according to the study.

“We’re unlikely to ever prevent all depression. So, we need measurement approaches that help us understand the impact of shortening exposure to depression rather than eliminating it entirely,” Dr Pence said. “This study implemented a novel approach to characterizing the cumulative burden of depression over time. We found that even a modest increase in the proportion of time spent depressed is related in a dose-response fashion to increased likelihood of missing HIV medical appointments, increased risk of failing HIV treatment and higher mortality rates.”

Each 25% increase in the number of days spent with depression resulted in an 8% increase in the risk of missed appointments, according to the study.

The 25% increase in days with depression also corresponded with a 5% increase in the risk of treatment failure and a 19% increase in mortality.

Significantly, the data showed that patients who spent the whole follow-up period depressed had a 37% increased risk of missing appointments, a 23% increased risk of treatment failure, and a doubled mortality rate compared with patients who spent no days depressed, according to the study.

These results suggest that physicians and other health care providers may not be correctly identifying depression among patients with HIV, according to the authors. Additionally, these patients may not have the resources to get treatment for depression, highlighting a potential opportunity to bridge this gap.

The authors note that next steps should include clinic-level trials of protocols to identify and treat patients with depression and HIV.

“Additional time spent depressed elevates the likelihood of failure at multiple points along the HIV care continuum,” Dr Pence said. “Even modest increases led to clinically meaningful upticks in negative outcomes. The implication is that regular depression screening and rapid, evidence-based treatment — by shortening the duration of depression – hold the potential to have a meaningful impact on HIV outcomes.”