A comprehensive analysis of excess depressive disorder in women and men living with HIV in France compared to the general population

Abstract

We aimed to estimate the prevalence of depressive disorder in people living with HIV (PLWH) and evaluate its association with non-HIV-specific and HIV-specific factors in PLWH and in PLWH compared to the general population (GP). We used cross-sectional data from the QuAliV study, conducted within the ANRS-CO3 Aquitaine-AQUIVIH-NA cohort of PLWH in Nouvelle-Aquitaine (2018–2020), and a nationally-representative survey in the GP (EHIS-ESPS, 2014–2015), we included all participants aged ≥ 18 years old who had completed the Patient Health Questionnaire-8 (PHQ-8). Depressive disorder was defined as Patient Health Questionnaire-8 score greater or equal to 10. Its association with non-HIV-specific (demographic, socio-economic, behavioral, health status), HIV-specific factors (immuno-viral markers, antiretrovirals, level of perceived HIV-stigma), and HIV-status was assessed using Poisson regression models with robust variance in women and men separately. We included 914 PLWH (683 men/231 women). More than one in five PLWH had depressive disorder. It was strongly associated with being younger and experiencing severe pain in both sexes. Unemployment in women, being single, and lack of family ties in men were also associated with depressive disorder. More than 30% of our sample reported HIV-stigma, with a dose–response relationship between level of perceived HIV-stigma and depressive disorder. The crude prevalence of depressive disorder was 2.49 (95%CI 1.92–3.22) and 4.20 (95%CI 3.48–5.05) times higher in women and men living with HIV respectively compared to GP counterparts and 1.46 (95%CI 1.09–1.95) and 2.45 (95%CI 1.93–3.09) times higher after adjustment for non-HIV specific factors. The adjusted prevalence ratio of depressive disorder was not significantly different in HIV-stigma free women, but remained twice as high in HIV-stigma free men. The prevalence of depressive disorder compared to the GP tended to decrease with age in PLWH. Excess depressive disorder remains a major concern in PLWH. Our findings reaffirm the importance of regular screening. Tackling social inequalities and HIV-stigma should be prioritized to ensure that PLWH achieve good mental as well as physical health outcomes.

Factors associated with poorer quality of life in people living with HIV in southwestern France in 2018–2020 (ANRS CO3 AQUIVIH-NA cohort: QuAliV study)

“…This finding is consistent with previous research, showing HIV-related stigma to be strongly associated with poorer HRQoL, specifically in the psychological and social QoL 26 , 27 . Similar patterns have been observed in research on depressive syndrome in PLWH compared to those in the general population, wherein we observed a dose–response relationship between the prevalence of depressive syndrome and level of HIV-related stigma 28 . Different forms of HIV-related stigma, which are potentially compounded by intersectional stigma faced by populations disproportionately affected by HIV (e.g.…”

Prevalence of Mental Health Disorders and Their Associated Risk Factors Among People Living with HIV in Rwanda: A Cross-Sectional Study

“…It has previously been shown that PLWH are more likely to suffer from mental health disorders than the general population [10,[12][13][14]. In this study, the burden of MDE and PTSD among PLWH was higher than in the Rwandan general population, but the difference was statistically non-significant.…”

“…Mental health disorders are among the NCDs which pose a substantial burden of disease for this population [7][8][9][10]. According to a recent systematic review, up to 62% of PLWH experience mental health symptoms [10], and particularly depression is common among PLWH with prevalence rates up to 4 times higher than in the general population [10][11][12][13][14]. In addition to the burden of disease, comorbidity of mental health disorders among PLWH can complicate medication adherence [15][16][17], jeopardize viral suppression [18,19], and increase the risk of clinical HIV progression [20,21].…”

Microglia Involves in the Immune Inflammatory Response of Poststroke Depression: A Review of Evidence

“…In addition, the injection of interferon- γ and poly(I:C), a Toll-like receptor-3 (TLR3) agonist mimicking the effect of HCV double-strand RNA, caused depression-like symptoms, and the proinflammatory genes were synergistically induced in the hippocampus and prefrontal cortex [ 105 ]. The tight association between HCV infection and depression suggests that optimal care for the overall well-being of patients with HCV infection needs adequate knowledge of their psychological status [ 114 ]. Infection with human immunodeficiency virus (HIV) has been associated with an increase in the prevalence of depression [ 115 , 116 ].…”