Depression Prevalence, Antidepressant Treatment Status, and Association with Sustained HIV Viral Suppression Among Adults Living with HIV in Care in the United States, 2009–2014

Abstract

Previous research indicates a high burden of depression among adults living with HIV and an association between depression and poor HIV clinical outcomes. National estimates of diagnosed depression, depression treatment status, and association with HIV clinical outcomes are lacking. We used 2009-2014 data from the Medical Monitoring Project to estimate diagnosed depression, antidepressant treatment status, and associations with sustained viral suppression (all viral loads in past year < 200 copies/mL). Data were obtained through interview and medical record abstraction and were weighted to account for unequal selection probabilities and non-response. Of adults receiving HIV medical care in the U.S. and prescribed ART, 27% (95% confidence interval [CI] 25-29%) had diagnosed depression during the surveillance period; the majority (65%) were prescribed antidepressants. The percentage with sustained viral suppression was highest among those without depression (72%, CI 71-73%) and lowest among those with untreated depression (66%, CI 64-69%). Compared to those without depression, those with a depression diagnosis were less likely to achieve sustained viral suppression (aPR 0.95, CI 0.93-0.97); this association held for persons with treated depression compared to no depression (aPR 0.96, CI 0.94-0.99) and untreated depression compared to no depression (aPR 0.92, CI 0.89-0.96). The burden of depression among adults living with HIV in care is high. While in our study depression was only minimally associated with a lower prevalence of sustained viral suppression, diagnosing and treating depression in persons living with HIV remains crucial in order to improve mental health and avoid other poor health outcomes.

Interventions Addressing Depression and HIV-Related Outcomes in People with HIV

“…People with HIV (PWH) experience a higher prevalence of depression than the general population. In nationally representative and clinic-based samples of PWH [1][2][3][4], depression ranges from 12.4 to 67%, which is three to eight times more than the general population (4.4%) [5]. Depression can present with a variety of symptoms, such as low mood or energy, lack of interest or concentration, and feelings of guilt, as well as changes in appetite, sleep habits, and psychomotor activity [6].…”

Using the Patient Portal Sexual Health Instrument in Surveys and Patient Questionnaires Among Sexual Minority Men in the United States: Cross-sectional Psychometric Validation Study (Preprint)

“…Factors such as patient-provider communication barriers and anticipated health care stigma experienced among SMM are known to hinder the use of STI preventive services such as testing [39][40][41]. In addition, controlling HIV is harder among persons with mental health issues, resulting in lower rates of HIV virologic suppression [42,43]. In a call to action for comprehensive HIV services for SMM, Beyrer et al [44] recommend health providers to provide integrated mental health services for SMM.…”

Latinxs with HIV: Depressive Cognitive Alterations as a Precursor to Cardio-Motor Deficits

“…Simoni et al, [28] hold that the occurrence of depression in PLHIV is uniquely detrimental, as the mental health affliction interferes with necessary actions required for optimally managing HIV, such as adherence to ART, beginning ART following the increase in HIV RNA levels and decrease in CD4 cell counts, lack of initiating ART entirely, and impaired self-care behaviors. These interferences have the ability to cause a plethora of spiraling negative outcomes that can lead to decreased viral suppression and life expectancy [26][27]. Latinxs with HIV, however, have distinctive strains associated with depression; the rates of depression among the Latinx population are higher than their non-Hispanic counterparts, yet only 20% of these individuals who are depressed speak to their primary care physician about their struggles, and only 10% go on to receive treatment for their mental health disorder [44].…”

“…Cognitive disruptions as a result of mental health disorders are also found in people with HIV, of which the most prevalent comorbidity is depression, as it occurs in 41% of those diagnosed with the virus [25]. Depression is nearly three times as likely to develop in HIV-infected individuals than in the noninfected population and presents a plethora of negative outcomes, including a further reduction in life expectancy and decreased chances of achieving viral suppression [26][27][28]. In those who have depression but do not suffer from HIV, cognitive and functional impairments, such as memory disorders, slow thoughts and responses, and frequent vegetative states, are common [29].…”