Depression and Neurocognitive Performance in Portuguese Patients Infected with HIV

Abstract

This study focused on neurocognitive disorders associated with HIV infection, characterizes the most affected neuropsychological domains and their potential as factors related with depression. 130 HIV-positive individuals with CD4 [200 cells/mm 3 , undetectable viral load, treated with HAART and with all kinds of risk behaviors were included. A structured interview composed by seven sections was used and relevant clinical and laboratory data was assessed. For the neuropsychological and depression assessment the HIV Neurobehavioral Research Center (HNRC) Battery and Hamilton Rating Scale for Depression (HAM-D) were chosen. Univariate nonparametric statistics and multivariate regression model were performed. Among 34% of depressed subjects, 20.7% had attempted suicide, 45.4% were under psychiatric medication and only 19% had no diagnostic criteria for HIV Associated Neurocognitive Disorders (HAND). The effect of depression on cognitive function revealed a significant deterioration in five of the eight measures. In the multivariate analysis, five variables significantly determined depression: sex, social class, antidepressant medication, history of suicide attempt and Dexterity and motor speed (neuropsychological test battery). Despite good patient adherence to treatment (HAART and antidepressive) and good immune status, the prevalence of HAND and depression are high and suggest a significant relation between severity of depression and cognitive functioning.Resumen Este estudio se centra en los trastornos neurocognitivos asociados a la infección por el VIH, caracteriza los dominios neuropsicológicos más afectados y su potencial relación con la depresión. Fueron incluidos en el estudio 130 individuos VIH-positivos con CD4[200 células/mm 3 , carga viral indetectable, medicados con HAART abarcando todos los comportamientos de riesgo. Fue utilizada una entrevista estructurada compuesta por siete secciones y se evaluaron los datos clínicos y de laboratorio. Para la evaluación neuropsicológica y la depresión fueron elegidas la batería de lo HNRC (HIV Neurobehavioral Research Center) y la Escala de Hamilton para Depresión (HAM-D). Se utilizaran estadísticas univariantes no paramétricas y el modelo de regresión multivariante. Entre el 34% de los sujetos deprimidos, el 20,7% había intentado suicidarse, el 45,4% hacían medicación psiquiátrica, y sólo el 19% carecía de criterios para el diagnóstico trastornos neurocognitivos asociado al VIH (HAND). El efecto de la depresión sobre la función cognitiva revela un deterioro significativo en cinco de las ocho medidas. En el análisis multivariado, cinco variables se asocian significativamente con la depresión: el sexo, la clase social, los medicamentos antidepresivos, la historia de intentos de suicidio y la destreza y velocidad motora (batería neuropsicológica). A pesar de buena adherencia de los pacientes al tratamiento (HAART y antidepresivos) y del buen estado inmunológico, la prevalencia de HAND y depresión son altas y sugieren una relación significativa entre la gravedad de la...

Depressive Symptoms and Neurocognitive Performance Among HIV-Infected Women

“…Although preliminary, this study offers an important contribution to the field, especially because women are still under-represented in neuropsychological studies of HIV (Maki & Martin-Thormeyer, 2009) Firstly, our findings indicate that HIV-infected women experience high levels of depressive symptoms. These findings are consistent with prior work that revealed a significant prevalence of depression among HIV-infected patients (Leserman, 2003, Ciesla & Roberts, 2001, and particularly among women (Bragança & Palha, 2011;Pereira & Canavarro, 2011;Ickovics et al, 2001;Rabkin, 2008;Valverde et al, 2007). In our study the percentage of HIV-infected women showing severe depressive symptoms (31.1%) was higher than that found in past studies (Mello, Segurado, & Malbergier, 2010;Morrison et al, 2002).…”

“…Depressive symptoms are a risk factor for neurocognitive impairment in HIV-infected individuals (Bragança & Palha, 2011;Vásquez-Justo et al, 2003;Waldrop-Valverde et al, 2005); however, research has produced mixed findings, with some studies being unable to identify any significant association between depressive symptoms and neurocognitive impairment (Applebaum et al, 2010;Ammassari et al, 2004;Carter et al, 2003;Cysique et al, 2007) or identifying only a minimal association (Goggin et al, 1997). Although these studies have examined the combined effect of HIV and depressive symptoms on neurocognitive performance, to our knowledge, none of these studies examined this specific relationship in an all-female sample.…”

Prevalence of neurocognitive disorders and depression in a Brazilian HIV population

“…A previous study suggests an association between depression and neurocognitive disorders in HIV+ patients (20) . In Brazil, the prevalence of depression in HIV+ patients has been reported between 32 and 34.5% (13) (19) .…”

sychiatry and HIV infection: what changed?

“…Major diagnostic categories (in %) of patients followed in the study centre. Although there are various studies that found no relation between severity of depressive symptoms and neuropsychological impairment [24,25], another suggests a significant relationship between these two variables in HIV-infected patients: with the exception of memory, the greater the severity of depression, the greater is the decline in cognitive domains [26].…”