TY - JOUR
T1 - Depressive Symptoms and Engagement in Human Immunodeficiency Virus Care Following Antiretroviral Therapy Initiation
AU - Bengtson, Angela M.
AU - Pence, Brian W.
AU - Mimiaga, Matthew J.
AU - Gaynes, Bradley N.
AU - Moore, Richard
AU - Christopoulos, Katerina
AU - O'Cleirigh, Conall
AU - Grelotti, David
AU - Napravnik, Sonia
AU - Crane, Heidi
AU - Mugavero, Michael
N1 - Funding Information:
Financial support. We thank the National Institutes of Health (NIH; grants R01MH100970, R24AI067039, L30 MH110572, K99MH112413) for their support of this work. We also thank the Center for AIDS Research sites involved in CNICS including the University of Alabama at Birmingham (P30 AI027767), University of Washington (P30 AI027757), University of California–San Diego (P30 AI036214), University of California–San Francisco (P30 AI027763), Case Western Reserve University (P30 AI036219), Johns Hopkins University (P30 AI094189, U01 DA036935), Fenway Health/Harvard (P30 AI060354), and University of North Carolina Chapel Hill (P30 AI50410).
Funding Information:
Potential conflicts of interest. K. C. reports grants from the NIH during the conduct of the study and grants and personal fees from Gilead and personal fees from Roche outside the submitted work. H. C. reports grants from the NIH during the conduct of the study and grants from the NIH and Patient-Centered Outcomes Research Institute, and from VIIV, outside the submitted work. All other authors report no conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2019/1/18
Y1 - 2019/1/18
N2 - The effect of depressive symptoms on progression through the human immunodeficiency virus (HIV) treatment cascade is poorly characterized. Methods. We included participants from the Centers for AIDS Research Network of Integrated Clinic Systems cohort who were antiretroviral therapy (ART) naive, had at least 1 viral load and HIV appointment measure after ART initiation, and a depressive symptom measure within 6 months of ART initiation. Recent depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) and categorized using a validated cut point (PHQ-9 =10). We followed participants from ART initiation through the first of the following events: loss to follow-up (12 months with no HIV appointment), death, administrative censoring (2011-2014), or 5 years of follow-up. We used log binomial models with generalized estimating equations to estimate associations between recent depressive symptoms and having a detectable viral load (=75 copies/mL) or missing an HIV visit over time. Results. We included 1057 HIV-infected adults who contributed 2424 person-years. At ART initiation, 30% of participants reported depressive symptoms. In multivariable analysis, recent depressive symptoms increased the risk of having a detectable viral load (risk ratio [RR], 1.28; 95% confidence interval [CI], 1.07, 1.53) over time. The association between depressive symptoms and missing an HIV visit (RR, 1.20; 95% CI, 1.05, 1.36) moved to the null after adjustment for preexisting mental health conditions (RR, 1.00; 95% CI, 0.85, 1.18). Conclusions. Recent depressive symptoms are a risk factor for unsuppressed viral load, while preexisting mental health conditions may influence HIV appointment adherence.
AB - The effect of depressive symptoms on progression through the human immunodeficiency virus (HIV) treatment cascade is poorly characterized. Methods. We included participants from the Centers for AIDS Research Network of Integrated Clinic Systems cohort who were antiretroviral therapy (ART) naive, had at least 1 viral load and HIV appointment measure after ART initiation, and a depressive symptom measure within 6 months of ART initiation. Recent depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) and categorized using a validated cut point (PHQ-9 =10). We followed participants from ART initiation through the first of the following events: loss to follow-up (12 months with no HIV appointment), death, administrative censoring (2011-2014), or 5 years of follow-up. We used log binomial models with generalized estimating equations to estimate associations between recent depressive symptoms and having a detectable viral load (=75 copies/mL) or missing an HIV visit over time. Results. We included 1057 HIV-infected adults who contributed 2424 person-years. At ART initiation, 30% of participants reported depressive symptoms. In multivariable analysis, recent depressive symptoms increased the risk of having a detectable viral load (risk ratio [RR], 1.28; 95% confidence interval [CI], 1.07, 1.53) over time. The association between depressive symptoms and missing an HIV visit (RR, 1.20; 95% CI, 1.05, 1.36) moved to the null after adjustment for preexisting mental health conditions (RR, 1.00; 95% CI, 0.85, 1.18). Conclusions. Recent depressive symptoms are a risk factor for unsuppressed viral load, while preexisting mental health conditions may influence HIV appointment adherence.
KW - HIV
KW - HIV treatment cascade
KW - depression
KW - mental health
KW - viral load.
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U2 - 10.1093/cid/ciy496
DO - 10.1093/cid/ciy496
M3 - Article
C2 - 29901695
AN - SCOPUS:85060159534
SN - 1058-4838
VL - 68
SP - 475
EP - 481
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 3
ER -