The effect of antidepressant treatment on HIV and depression outcomes

Abstract

Background Depression is a major barrier to HIV treatment outcomes. Objective Test whether antidepressant management decision support integrated into HIV care improves antiretroviral adherence and depression morbidity. Design Pseudo-cluster randomized trial. Setting Four US infectious diseases clinics. Participants HIV-infected adults with major depressive disorder. Intervention Measurement-Based Care: depression care managers used systematic metrics to give HIV primary-care clinicians standardized antidepressant treatment recommendations. Measurements Primary: Antiretroviral medication adherence (monthly unannounced telephone-based pill counts for 12m). Primary timepoint: 6m. Secondary: Depressive severity, depression remission, depression-free days, measured quarterly for 12m. Results From 2010-2013, 149 participants were randomized to intervention and 155 to usual care. Participants were mostly male, Black non-Hispanic, unemployed, and virally suppressed with high baseline self-reported antiretroviral adherence and depressive severity. Over follow-up, no differences between arms in antiretroviral adherence or other HIV outcomes were apparent. At 6 months, depressive severity was lower among intervention participants than usual care (mean difference −3.7 [95% CI: −5.6, −1.7]), probability of depression remission was higher (risk difference 13% [1%, 25%]), and suicidal ideation was lower (RD −18% [−30%, −6%]). By 12 months the arms had comparable mental health outcomes. Intervention arm participants experienced an average of 29 (95% CI: 1-57) more depression-free days over 12 months. Conclusions In the largest trial of its kind among HIV-infected adults, MBC did not improve HIV outcomes, possibly because of high baseline adherence, but achieved clinically significant depression improvements and increased depression-free days. MBC may be an effective, resource-efficient approach to reducing depression morbidity among HIV patients.

Association between Perceived Discrimination in Healthcare Settings and HIV Medication Adherence: Mediating Psychosocial Mechanisms

“…56 Future research may consider the feasibility of incorporating an internalized stigma reduction component into an existing and efficacious behavioral intervention for depression and adherence, 57 or in combination with a medical intervention for depression, which have achieved clinically significant improvements in symptoms of depression but have had limited effects on ART adherence. 58 …”

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

“…110,134 Depression treatment improved ART adherence 150 and HIV outcomes 151 ; however, 3 US-based randomized clinical trials of antidepressant treatment showed no effect on ART adherence. 152–154 More intensive behavioral interventions integrating depression and adherence counseling showed improvement in both outcomes. 155–157 …”

A multinational qualitative investigation of the perspectives and drivers of exercise and dietary behaviors in people living with HIV

“…PLWH experience a high symptom burden that can be hard to manage, but can be improved with engagement in healthy self-management behaviors such as exercise (Barroso & Voss, 2013; Pence et al, 2015; Watkins & Treisman, 2015). In addition to improving health, developing interventions that help PLWH engage in regular, moderate-to-vigorous exercise and eating a healthy, balanced diet, are likely to have a significant effect on symptom burden.…”