Impact of Depression and Anxiety on Initiation of Antiretroviral Therapy Among Men Who Have Sex with Men with Newly Diagnosed HIV Infections in China

Abstract

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.

Switch to dolutegravir is well tolerated in Thais with HIV infection

“…The superior tolerability to DTG among ART‐experienced people could be related to the absence of neuropsychological symptoms that often accompany a new diagnosis of HIV , an already induced liver metabolism or a higher tolerance of AEs. Our cohort had had more than two years on ART and a decrease of clinically relevant depressive and anxiety symptoms with time, concurrent with ART .…”

HIV care continuum characteristics among people with opioid use disorder and HIV in Vietnam: baseline results from the BRAVO study

“…This association has not, to our knowledge, been explored in Vietnam to date. Authors working in China suggest that subpopulations of patients with depression may have differing levels of ART initiation [36]; our study suggests that patients with increased depression symptoms were less likely to have initiated ART at baseline. This warrants further investigation, particularly as a recent study in Vietnam showed that one-fifth of patients living with HIV who were sampled endorsed depression symptoms [38].…”

“…To our knowledge, similar results have not been reported in Vietnam; however, research in China [29] and South Table 1 Unadjusted and adjusted associations between baseline characteristics and ART prescription and viral suppression among people with HIV and opioid use disorder in Vietnam, 2015-2019 (Continued) Africa [30] has shown that marriage may be positively associated with ART initiation. While depression is associated with suboptimal ART adherence [31] [32], studies are mixed on its potential association with ART initiation, with several studies demonstrating an absence of association [33][34][35][36][37]. This association has not, to our knowledge, been explored in Vietnam to date.…”

ART initiation and predictive factors among men who have sex with men living with HIV after the implementation of new ART strategy in China: an observational cohort study

“…However, HIV positive MSM reported lower ART use than other HIV-infected groups and required more attention [21]. Before the era of "treat all" (in 2013), a group of newly diagnosed HIV positive MSM in China was offered free ART regardless of their CD4 counts, only 62% of them started ART within one year [22]. Another study conducted after the implementation of "threat all" (in 2016) reported that 69.9% of HIV-positive MSM with CD4 counts >350 cells/mm 3 intended to initiate ART [23].…”

“…Mental health problems (e.g., depression and anxiety) are the most commonly reported comorbid conditions of PLWH [33]. Previous studies showed high prevalence of depression and anxiety among HIV positive MSM (40%) [22,34]. Mental health problems were reported to contribute to delays in ART initiation among PLWH in general and HIV-positive MSM [35][36][37].…”