Depression and HIV infection: impact on immune function and disease progression

The association of changes in depression severity after the onset of the COVID-19 pandemic and viral nonsuppression among people with HIV

OBJECTIVE

This study sought to characterize changes in depressive symptom severity during the COVID-19 pandemic and the association of these changes with HIV viral nonsuppression among people with HIV (PWH).

DESIGN

A clinical cohort study.

METHODS

We included PWH in the Johns Hopkins HIV Clinical Cohort who completed the Patient Health Questionnaire 8 (PHQ-8) prepandemic (1 March 2018 to 28 February 2020) and during the COVID-era (1 September 2020 to 28 February 2022). PWH were classified according to depression severity categories prepandemic and during the COVID-era as: consistently depressed (prepandemic PHQ-8 >4 and no change in severity category); consistently nondepressed (prepandemic PHQ-8 ≤4 and no change in severity category); worsened (changed to a higher severity category) and; improved (change to a lower severity category). The association between changes in depressive symptom severity and viral nonsuppression (HIV RNA >200 copies/ml on the earliest viral load measured 7 days before to 12 months after the COVID-era PHQ-8 survey) was assessed using multivariable logistic regression.

RESULTS

Of 793 PWH, mean age was 56 (SD 10) years, 60% were male individuals and 88% were Black. After the onset of the pandemic, 60% were consistently nondepressed, 9% were consistently depressed, 15% worsened and 16% improved. PWH who worsened had 2.47 times the odds of viral nonsuppression (95% CI: 1.09-5.55) compared with the nondepressed group. Associations among other groups were not statistically significant.

CONCLUSION

Worsening depression during the COVID-era was associated with HIV viral nonsuppression. Strategies to monitor and address depression among PWH may contribute to reduced risk of viral nonsuppression.

Depression as a mediator between intimate partner violence (IPV) and CD4 cell count among men who have sex with men (MSM) living with HIV in China

Intimate partner violence (IPV) is associated with adverse mental and physical outcomes among men who have sex with men (MSM) living with HIV. Few studies focus on psychological IPV, such as verbal threats. This study examined the associations between different forms of IPV and depression and CD4+ cell count, with depression as a mediator for the association between IPV and CD4+ cell count. Data for these analyses were derived from a larger cross-sectional study on HIV-HCV co-infection among MSM in Shanghai, China (N = 1623). We estimated the average causal mediation effects (ACME) and average direct effects (ADE) through three steps. About 16% of participants experienced IPV, with forced sex (7%), verbal threats (5%), and thrown objects (4%) being most common. Verbal threats showed the strongest link with depression and low CD4+ cell count. Depression fully mediated the relationship between verbal abuse and low CD4+ cell count, suggesting it as a potential pathway between psychological IPV and poorer HIV-related health outcomes. More research on psychological IPV is warranted to examine its health impacts. Mental health could be a potential focus of intervention to enhance HIV-related health outcomes among MSM with IPV experience.

Depression during the COVID-19 pandemic among people living with HIV: Are low HIV/AIDS stigma and high perceived emotional support protective resources?

This study has two objectives: first, to examine changes in depressive symptoms among people living with HIV (PLWH) during the COVID-19 pandemic and, second, to verify the role of HIV/AIDS stigma and perceived emotional support (PES) in the heterogeneity of these changes. The participants were 392 people with a medical diagnosis of HIV who have undergone antiretroviral therapy. Depression was measured at three time points with 6-month intervals using the Centre for Epidemiological Studies Depression Scale (CES-D). PES was evaluated with the Berlin Social Support Scales, and HIV/AIDS-related stigma was assessed with the Berger HIV Stigma Scale. Latent growth class modelling identified four trajectories of depression over the study period: three stable (very high, high, and very low) and one increasing. Both the very high and high stable trajectories had baseline values above the CES-D cut-off point for depression, suggesting that 57.6% of the sample was likely to be diagnosed with depression. After controlling for sociodemographic and clinical variables, stigma and PES were found to be significant covariates of the obtained trajectories; however, they did not protect against an increase in depression symptoms. There was no overall increase in depression symptoms among the PLWH participants during the pandemic, but this change in depression symptoms was heterogeneous. We observed the potential development of depression in initially well-functioning individuals despite their personal resources differing only slightly from those who remained resilient.

The Associations Between Loneliness, Hopelessness, and Self-control and Internet Gaming Disorder Among University Students Who Were Men Who Have Sex With Men: Cross-sectional Mediation Study

BACKGROUND

The minority stress model postulates that men who have sex with men (MSM) often encounter multiple stressors because of their sexual minority status, which may lead to psychological problems and maladaptive coping such as addictive behaviors (eg, internet gaming disorder [IGD]). It was hypothesized that hopelessness and loneliness would be associated with IGD via self-control among MSM.

OBJECTIVE

This study investigated the prevalence of IGD and its associations with variables related to minority stress (loneliness and hopelessness) among MSM who were university students. Mediation involving such associations via self-control was also explored.

METHODS

With informed consent, 305 MSM attending universities in Sichuan, China participated in the study. The validated Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) checklist was used to assess IGD. Multivariable logistic regression adjusted for background factors and structural equation modeling were conducted.

RESULTS

The prevalence of IGD was 12.8% (n=39). Logistic regression found that IGD was positively associated with hopelessness and loneliness, and negatively associated with self-control. The structural equation modeling identified three significant paths between hopelessness/loneliness and IGD: (1) hopelessness → lower self-control → higher IGD (full mediation), (2) loneliness → lower self-control → higher IGD (partial mediation: effect size of 28%), and (3) a direct effect from loneliness to IGD.

CONCLUSIONS

IGD was prevalent among young MSM and warrants interventions that may try to reduce the level of psychosocial problems such as loneliness and hopelessness and improve self-control. According to the socioecological model, the promotion of social acceptance and reduction in stigma toward MSM are important in reducing loneliness and hopefulness among MSM. Self-control links up the relationships between psychosocial problems and IGD and should be given special attention. Longitudinal studies are warranted to confirm the findings and test new mediations between loneliness/hopelessness and MSM with IGD.

How food support improves mental health among people living with HIV: A qualitative study

BACKGROUND

Food insecurity is associated with poor mental health among people living with HIV (PLHIV). This qualitative study explored the mental health experiences of PLHIV participating in a medically appropriate food support program.

METHODS

Semi-structured interviews were conducted post-intervention (n = 34). Interview topics included changes, or lack thereof, in mental health and reasons for changes. Interviews were audio-recorded, transcribed, and double-coded. Salient themes were identified using an inductive-deductive method.

RESULTS

Positive changes in mental health self-reported by PLHIV included improved mood and reduced stress, worry, and anxiety. Participants attributed these changes to: 1) increased access to sufficient and nutritious foods, 2) increased social support, 3) reduced financial hardship, 4) increased sense of control and self-esteem, and 5) reduced functional barriers to eating.

CONCLUSIONS

Medically appropriate food support may improve mental health for some PLHIV. Further work is needed to understand and prevent possible adverse consequences on mental health after programs end.

The impact of depression and post-traumatic stress symptoms on physical health perceptions and functional impairment among sexual minority men living with HIV with histories of trauma

Mental health symptoms may compromise health-related quality of life (HRQOL), including among men who have sex with men (MSM) living with HIV, who experience high rates of trauma and other stressors. This study sought to examine the relative contributions of post-traumatic stress disorder (PTSD) symptoms, depression symptoms, and biological indices of HIV disease status on HRQOL in this population. Participants were 79 MSM with HIV (49% White; 35% Black; 8% Hispanic/Latinx) with trauma histories (52% met current PTSD diagnostic criteria). HRQOL outcomes were general perceptions of health (0-100 visual analog scale) and functional disability (WHODAS 2.0). Dominance analysis was applied to examine the relative share of variance in these outcomes accounted for by PTSD symptom severity, depression symptom severity, viral suppression status, and CD4 count. Depression symptom severity accounted for 70% and 92% of variance in perceived health, respectively, across models (p's < 0.05). Both PTSD symptom severity (45%) and depression symptom severity (43%) scores also accounted for significant variance in functional disability (p's < 0.05). Medical indices of HIV disease progression did not explain significant variance in HRQOL in any model. A trauma-informed approach may aid clinicians in interpreting reports of health and physical functioning in MSM with HIV.

Pathophysiological Consequences of At-Risk Alcohol Use; Implications for Comorbidity Risk in Persons Living With Human Immunodeficiency Virus

At-risk alcohol use is a significant risk factor associated with multisystemic pathophysiological effects leading to multiorgan injury and contributing to 5.3% of all deaths worldwide. The alcohol-mediated cellular and molecular alterations are particularly salient in vulnerable populations, such as people living with HIV (PLWH), diminishing their physiological reserve, and accelerating the aging process. This review presents salient alcohol-associated mechanisms involved in exacerbation of cardiometabolic and neuropathological comorbidities and their implications in the context of HIV disease. The review integrates consideration of environmental factors, such as consumption of a Western diet and its interactions with alcohol-induced metabolic and neurocognitive dyshomeostasis. Major alcohol-mediated mechanisms that contribute to cardiometabolic comorbidity include impaired substrate utilization and storage, endothelial dysfunction, dysregulation of the renin-angiotensin-aldosterone system, and hypertension. Neuroinflammation and loss of neurotrophic support in vulnerable brain regions significantly contribute to alcohol-associated development of neurological deficits and alcohol use disorder risk. Collectively, evidence suggests that at-risk alcohol use exacerbates cardiometabolic and neurocognitive pathologies and accelerates biological aging leading to the development of geriatric comorbidities manifested as frailty in PLWH.

Major depressive disorder and its association with adherence to antiretroviral therapy and quality of life: cross-sectional survey of people living with HIV/AIDS in Northwest Ethiopia

BACKGROUND

Major depression is believed to affect treatment adherence and overall quality of life (QoL) of people living with HIV/AIDS (PLWHA). Comorbid major depression contributes to a two-fold higher risk of mortality among PLWHA. Understanding the relationships of major depression, adherence to antiretroviral therapy (ART) and QoL is important to identify areas for intervention. The aim of this study is to examine relationship of major depressive disorder (MDD) and adherence to ART with QoL, and to investigate socio-demographic and clinical factors associated with MDD, adherence and QoL among PLWHA in Northwest Ethiopia.

METHOD

A cross-sectional study was conducted in the ART clinic of Felege-Hiwot referral hospital in Northwest Ethiopia from July to October 2019. Adult PLWHA were selected using a systematic random sampling technique. Data were collected using interview administered questionnaires and chart reviews. Mini International Neuropsychiatric Interview and WHOQOL-HIV-BREF-Eth instruments were used to measure MDD and QoL respectively. Adherence to ART was assessed using pill count data from patients' adherence monitoring chart. Univariate and multivariate Poisson regressions were used to assess associations of socio-demographic and clinical factors with MDD and adherence to ART. A multivariate linear regression was used to examine the associations of both MDD and adherence with overall QoL.

RESULT

Of the total of 393 invited participants, 391 (99.5%) completed the interviews. MDD was negatively associated with overall QoL: participants with MDD had a lower QoL score of 0.17 points compared to those with no MDD. MDD was associated with reduced adherence to ART when functional disability was controlled (RR = 1.43; 95%CI = 1.05, 1.96; p = 0.025). However, there was no statistical association between adherence to ART and overall QoL. Functional disability was associated with both MDD (RR = 5.07; 95%CI = 3.27,7.86; p < 0.001) and overall QoL (β = 0.29; 95%CI = 0.21,0.36; p < 0.001).

CONCLUSION

The relationship between MDD and QoL indicates the need for feasible, acceptable and evidence-based mental health interventions to reduce depression and improve overall QoL of PLWHA. We recommend future studies investigate causal relationships of MDD, adherence to ART and QoL of PLWHA to better understand priority areas for intervention.

HIV-Related Stress Experienced by Newly Diagnosed People Living with HIV in China: A 1-Year Longitudinal Study

This study explored the HIV-related stressors that people living with HIV (PLWH) commonly experience and express as stressful at the time of diagnosis and 1 year later. The factors associated with stress levels and whether social support would moderate the negative effects of stress on psychological health (depressive and anxiety symptoms) were also investigated. Newly diagnosed PLWH were consecutively recruited in this study. Participants rated their stress with the HIV/AIDS Stress Scale at baseline and 1 year later. Social support, depression, and anxiety were also self-reported at both time points. There were significant decreases in stress levels 1 year after diagnosis. Stressors regarding confidentiality, disclosure, emotional distress, fear of infecting others, and excessive attention to physical functions were the most problematic at baseline and 1-year follow-up. A younger age, married status, not living alone, less income, presence of HIV symptoms, and lack of social support were associated with higher levels of stress. No stress-buffering effect of social support on depressive and anxiety symptoms was found in this study. Interventions to reduce stress among PLWH should take into consideration the following priority stressors: confidentiality, discrimination/stigma, serostatus disclosure, distressing emotions, fear of infecting others, and excessive attention to physical functions. More attention should be paid to PLWH with younger age, not living alone, less income, presence of HIV symptoms, and lack of social support.

Impact of intimate partner violence on clinic attendance, viral suppression and CD4 cell count of women living with HIV in an urban clinic setting

The substance abuse, violence and HIV/AIDS (SAVA) syndemic represents a complex set of social determinants of health that impacts the lives of women. Specifically, there is growing evidence that intimate partner violence (IPV) places women at risk for both HIV acquisition and poorer HIV-related outcomes. This study assessed prevalence of IPV in an HIV clinic setting, as well as the associations between IPV, symptoms of depression and PTSD on three HIV-related outcomes-CD4 count, viral load, and missed clinic visits. In total, 239 adult women attending an HIV-specialty clinic were included. Fifty-one percent (95% CI: 45%-58%) reported past year psychological, physical, or sexual intimate partner abuse. In unadjusted models, IPV was associated with having a CD4 count <200 (OR: 3.284, 95% CI: 1.251-8.619, p = 0.016) and having a detectable viral load (OR: 1.842, 95% CI: 1.006-3.371, p = 0.048). IPV was not associated with missing >33% of past year all type clinic visits (OR: 1.535, 95% CI: 0.920-2.560, p = 0.101) or HIV specialty clinic visits (OR: 1.251, 95% CI: 0.732-2.140). In multivariable regression, controlling for substance use, mental health symptoms and demographic covariates, IPV remained associated with CD4 count <200 (OR: 3.536, 95% CI: 1.114-11.224, p = 0.032), but not viral suppression. The association between IPV and lower CD4 counts, but not adherence markers such as viral suppression and missed visits, indicates a need to examine potential physiologic impacts of trauma that may alter the immune functioning of women living with HIV. Incorporating trauma-informed approaches into current HIV care settings is one opportunity that begins to address IPV in this patient population.

Increased risk of depression in non-depressed HIV infected men with sleep disturbance: Prospective findings from the Multicenter AIDS Cohort Study

OBJECTIVE

Sleep disturbance is a known risk factor for depression, but it is not known whether sleep disturbance contributes to greater risk of depression in those infected with human immunodeficiency virus (HIV+) as compared to those uninfected with HIV (HIV-).

METHODS

Using data from the Multicenter AIDS Cohort Study, a population-based prospective study of men who have sex with men (MSM), self-reported sleep disturbance (>2 weeks) and depressive symptoms (Clinical Epidemiologic Scale for Depression, CES-D) were assessed every 6 months over 12 years of follow-up. Adjusted mixed effects logistic regression analyses tested whether sleep disturbance predicted depression (CES-D ≥ 16) at the immediate subsequent visit, and so on over 12 years, in non-depressed HIV+(N = 1054; 9556 person-visits) and non-depressed HIV- (N = 1217; 12,680 person-visits). In HIV+ vs. HIV- MSM, linearly estimated average incidence of depression and normalized cumulative rate of depression over 12 years were compared.

RESULTS

In the HIV+ MSM, sleep disturbance was associated with a significant increase in depression 6 months later (OR = 1.6; 95% CI, 1.30, 1.96), which was significantly greater (P < .05) than in HIV- MSM (OR = 1.16; 95% CI, 0.94, 1.44). HIV status and sleep disturbance interacted (P < .001), such that incidence of depression and normalized cumulative rate of depression were greater in HIV+ with sleep disturbance than in HIV+ without sleep disturbance and HIV- groups (all P's < 0.001).

CONCLUSIONS

HIV+ persons who report sleep disturbance represent a high risk group to be monitored for depression, and possibly targeted for insomnia treatment to prevent depression. FUND: National Institute of Allergy and Infectious Diseases.

A Cross-Sectional Study of Depressive Symptoms and Risky Alcohol Use Behaviors Among HIV Primary Care Patients in New York City

An association between problem drinking and depression among HIV-infected individuals has been previously demonstrated; however, which specific risky drinking behaviors are associated with higher levels of depression has not yet been investigated. Using an adult sample of HIV-infected primary care patients (78% male, 94% Black or Hispanic), we investigated whether depressive symptoms are associated with various risky drinking behaviors. Participants were administered the Beck Depression Inventory-II to assess depressive symptoms, and the Alcohol Use Disorders and Associated Disabilities Interview Schedule-IV to evaluate alcohol involvement. Participants with depressive symptoms (26%) were at higher risk for alcohol dependence [adjusted odds ratio (AOR) 3.8; 95% CI 2.0-7.2], regular binge drinking (AOR 2.0; 95% CI 1.1-3.8), and regular daytime drinking (AOR 2.1; 95% CI 1.2-3.8), in comparison with their non-depressed counterparts. Because both depression and unhealthy drinking negatively affect medication adherence and clinical outcomes, a better understanding of the association between depression and certain risky drinking behaviors among HIV-infected individuals is vital to improving their care and prognoses.

Depression and Survival in a 17-Year Longitudinal Study of People With HIV: Moderating Effects of Race and Education

OBJECTIVE

The prevalence of clinically significant depressive symptoms is three times higher in people living with HIV than in the general population. Although studies have shown that depression predicts worse course with HIV, few have investigated its relationship with mortality, and none have had a 17-year follow-up period and been conducted entirely during the time since the advent of protease inhibitors.

METHODS

We followed a diverse sample of HIV-positive people (N = 177) in the mid-range of illness for a study on stress and coping. Participants were assessed every 6 months (for 12 years) via blood draw, questionnaires, and interview. Depression was measured using the Beck Depression Inventory. The study began in March 1997 and mortality was assessed in April 2014.

RESULTS

In the primary analysis depression, analyzed as a continuous variable, significantly predicted all-cause mortality (hazard ratio = 1.038, 95% confidence interval = 1.008-1.068). With Beck Depression Inventory scores dichotomized, the hazard ratio was 2.044 (95% confidence interval = 1.176-3.550). Furthermore, this result was moderated by race and educational attainment such that depression only predicted worse survival for non-African Americans and those with a college education or higher.

CONCLUSION

Depression is associated with worse long-term survival in people with HIV during 17 years of follow-up. Interventions targeting depression may improve well-being and potentially survival in individuals with HIV. However, since depression did not predict survival in African Americans or those with low education, more research is needed to identify risk factors for long term outcomes in these groups.

Pathogen-Host Defense in the Evolution of Depression: Insights into Epidemiology, Genetics, Bioregional Differences and Female Preponderance

Significant attention has been paid to the potential adaptive value of depression as it relates to interactions with people in the social world. However, in this review, we outline the rationale of why certain features of depression including its environmental and genetic risk factors, its association with the acute phase response and its age of onset and female preponderance appear to have evolved from human interactions with pathogens in the microbial world. Approaching the relationship between inflammation and depression from this evolutionary perspective yields a number of insights that may reveal important clues regarding the origin and epidemiology of the disorder as well as the persistence of its risk alleles in the modern human genome.

Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: Current Knowledge, Implications, and Future Directions

Alcohol use is common among people living with human immunodeficiency virus (HIV). In this narrative review, we describe literature regarding alcohol's impact on transmission, care, coinfections, and comorbidities that are common among people living with HIV (PLWH), as well as literature regarding interventions to address alcohol use and its influences among PLWH. This narrative review identifies alcohol use as a risk factor for HIV transmission, as well as a factor impacting the clinical manifestations and management of HIV. Alcohol use appears to have additive and potentially synergistic effects on common HIV-related comorbidities. We find that interventions to modify drinking and improve HIV-related risks and outcomes have had limited success to date, and we recommend research in several areas. Consistent with Office of AIDS Research/National Institutes of Health priorities, we suggest research to better understand how and at what levels alcohol influences comorbid conditions among PLWH, to elucidate the mechanisms by which alcohol use is impacting comorbidities, and to understand whether decreases in alcohol use improve HIV-relevant outcomes. This should include studies regarding whether state-of-the-art medications used to treat common coinfections are safe for PLWH who drink alcohol. We recommend that future research among PLWH include validated self-report measures of alcohol use and/or biological measurements, ideally both. Additionally, subgroup variation in associations should be identified to ensure that the risks of particularly vulnerable populations are understood. This body of research should serve as a foundation for a next generation of intervention studies to address alcohol use from transmission to treatment of HIV. Intervention studies should inform implementation efforts to improve provision of alcohol-related interventions and treatments for PLWH in healthcare settings. By making further progress on understanding how alcohol use affects PLWH in the era of HIV as a chronic condition, this research should inform how we can mitigate transmission, achieve viral suppression, and avoid exacerbating common comorbidities of HIV and alcohol use and make progress toward the 90-90-90 goals for engagement in the HIV treatment cascade.

HIV and Elevated Mental Health Problems: Diagnostic, Treatment, and Risk Patterns for Symptoms of Depression, Anxiety, and Stress in a National Community-Based Cohort of Gay Men Living with HIV

People living with HIV (PLHIV) have almost double the risk of depression than the rest of the population, and depression and anxiety among PLHIV have been linked with greater disease progression and other physical health problems. Studies to date, however, have focused almost exclusively on depression or general mental health. Much less research has investigated predictors of anxiety and generalized stress among HIV-positive gay men. This paper reports findings from a national community-based sample of 357 HIV-positive Australians gay men aged 18 years and older. Participants reported elevated rates of depression, anxiety, and generalized stress symptoms. A significant proportion of men with elevated depression and anxiety symptoms were not receiving treatment or had not been diagnosed. Risk factors for elevated mental health concerns included experiences of internalized stigma and discrimination. Anxiety was also associated with lower T-cell CD4 counts. A key protective factor was access to social support. The type of support, in particular emotional support, was found to be more important than the source of support. Our findings suggest that greater emphasis is needed on mental health screening and the provision of emotional support for PLHIV.

Factors associated with depression among adolescents living with HIV in Malawi

BACKGROUND

Prior research suggests that a high prevalence of depression, with a detrimental impact on treatment outcomes exists among HIV-infected youth. Data on potential risk factors of depression among HIV-infected youth in sub-Saharan Africa are scarce. This cross-sectional study aimed to identify contributory/protective factors associated with depression in Malawian adolescents 12-18 years old living with HIV.

METHODS

Depression was measured by a validated Chichewa version of the Beck Depression Inventory version-II (BDI-II) and the Children's Depression Rating Scale-Revised (CDRS-R). Data on variables thought to potentially be contributory/protective were collected and included: socio-demographics, past traumatic events/stressors, behavioural factors/social support, and bio-clinical parameters. Chi-square test or two-sample t-test was used to explore associations between factors and depression. Additional testing via linear/logistic regression, adjusting for age and sex, identified candidate variables (p < 0.1). Final regression models included variables with significant main effects and interactions.

RESULTS

Of the 562 participants enrolled (mean age, 14.5 years [SD 2.0]; 56.1% female), the prevalence of depression was 18.9%. In multivariate linear regression, the variables significantly associated with higher BDI-II score were female gender, fewer years of schooling, death in the family/household, failing a school term/class, having a boyfriend/girlfriend, not disclosed or not having shared one's HIV status with someone else, more severe immunosuppression, and bullied for taking medications. Bullying victimization was reported by 11.6% of respondents. We found significant interactions: older participants with lower height-for-age z-scores and dissatisfied with their physical appearance had higher BDI-II scores. In multivariate logistic regression, factors significantly associated with depression were: older age, OR 1.23 (95% CI 1.07-1.42); fewer years of schooling, OR 3.30 (95% CI 1.54-7.05); and bullied for taking medications, (OR 4.20 (95% CI 2.29-7.69).

CONCLUSION

Having fewer years of schooling and being bullied for taking medications were most clearly associated with depression. Programmes to support the mental health needs of HIV-infected adolescents that address issues such as disclosure, educational support, and, most notably, bullying may improve treatment outcomes and are recommended.

Depression and CD4 cell count among patients with HIV in a Nigerian University Teaching Hospital

OBJECTIVE

Depression is common in people living with HIV/AIDS and there is some evidence that depressive symptoms may have adverse effects on immune functioning. The purpose of this study was to determine the prevalence of current depressive disorder in patients with HIV/AIDS and its association with CD4 cell count.

METHODS

A consecutive sample of 310 patients with HIV/AIDS attending Out-patient clinic in Ahmadu Bello University Teaching Hospital (A.B.U.T.H.), Zaria, Nigeria was assessed. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to screen for depressive symptoms, and the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used to confirm the diagnosis of current depressive disorder. The CD4 cell counts of participants with depressive disorder were compared with those of participants without depressive disorder. Multiple regression analysis was conducted to identify socio-demographic and disease-related factors associated with depression.

RESULTS

Among the 310 HIV-infected participants assessed for depression, 14.2% had current depressive disorder. Adjusting for age, gender, education, occupation, and marital status, patients with CD4 counts < 150 cells/μl were more likely to be depressed.

CONCLUSION

Depression is common among HIV-infected persons in Nigeria and is associated with low CD4 cell counts. The screening and treatment of mental health problems such as depression should be considered an integral component of HIV care and support.

Successful coping in urban, community-dwelling older adults with HIV

By 2015, 50% of HIV-infected individuals in the United States will be 50 years of age and older. Examining successful coping in older adults with HIV could expand existing coping toolkits, enhance disease management, and improve overall outcomes. We explored how urban, community-dwelling older adults (N = 40) coped with HIV infection, comorbidities, and related stressors. Participants completed an individual or focus group interview session using open-ended questions formulated from extended participant observation. Data were analyzed for theme development using interpretive hermeneutics and qualitative content analysis. Stressors included HIV, comorbidities, fear, anger, stigma, and finances. Three themes for successful coping were identified: accessing support, helping selves and helping others, and tapping into spirituality. Participants engaged in active, meaning-based strategies to successfully cope with HIV and related stressors. These strategies can be adapted for other older adults with HIV, leading to holistic care and improved outcomes.

Depression and social functioning among HIV-infected and uninfected persons in South Africa

Depression and other health problems are common co-morbidities among persons living with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS). The aim of this study was to investigate depression, health status, and substance use in relation to HIV-infected and uninfected individuals in South Africa. Using a cross-sectional case-control design, we compared depression, physical health, mental health, problem alcohol use, and tobacco use in a sample of HIV-infected (N = 143) and HIV-uninfected (N = 199) respondents who had known their HIV status for two months. We found that depression was higher, and physical health and mental health were lower in HIV-positive than HIV-negative individuals. Poor physical health also moderated the effect of HIV infection on depression; HIV-positive individuals were significantly more depressed than HIV-negative controls, but only when general physical health was also poor. We did not find an association between alcohol or tobacco use and HIV status. These results suggest the importance of incorporating the management of psychological health in the treatment of HIV.

Prevalence of depression and validation of the Beck Depression Inventory-II and the Children's Depression Inventory-Short amongst HIV-positive adolescents in Malawi

INTRODUCTION

There is a remarkable dearth of evidence on mental illness in adolescents living with HIV/AIDS, particularly in the African setting. Furthermore, there are few studies in sub-Saharan Africa validating the psychometric properties of diagnostic and screening tools for depression amongst adolescents. The primary aim of this cross-sectional study was to estimate the prevalence of depression amongst a sample of HIV-positive adolescents in Malawi. The secondary aim was to develop culturally adapted Chichewa versions of the Beck Depression Inventory-II (BDI-II) and Children's Depression Inventory-II-Short (CDI-II-S) and conduct a psychometric evaluation of these measures by evaluating their performance against a structured depression assessment using the Children's Rating Scale, Revised (CDRS-R).

STUDY DESIGN

Cross-sectional study.

METHODS

We enrolled 562 adolescents, 12-18 years of age from two large public HIV clinics in central and southern Malawi. Participants completed two self-reports, the BDI-II and CDI-II-S, followed by administration of the CDRS-R by trained clinicians. Sensitivity, specificity and positive and negative predictive values for various BDI-II and CDI-II-S cut-off scores were calculated with receiver operating characteristics analysis. The area under the curve (AUC) was also calculated. Internal consistency was measured by standardized Cronbach's alpha coefficient, and correlation between self-reports and CDRS-R by Spearman's correlation.

RESULTS

Prevalence of depression as measured by the CDRS-R was 18.9%. Suicidal ideation was expressed by 7.1% (40) using the BDI-II. The AUC for the BDI-II was 0.82 (95% CI 0.78-0.89) and for the CDI-II-S was 0.75 (95% CI 0.70-0.80). A score of ≥13 in BDI-II achieved sensitivity of >80%, and a score of ≥17 had a specificity of >80%. The Cronbach's alpha was 0.80 (BDI-II) and 0.66 (CDI-II-S). The correlation between the BDI-II and CDRS-R was 0.42 (p<0.001) and between the CDI-II-S and CDRS-R was 0.37 (p<0.001).

CONCLUSIONS

This study demonstrates that the BDI-II has sound psychometric properties in an outpatient setting among HIV-positive adolescents in Malawi. The high prevalence of depression amongst HIV-positive Malawian adolescents noted in this study underscores the need for the development of comprehensive services for HIV-positive adolescents.

Depressive symptoms and antiretroviral therapy (ART) initiation among HIV-infected Russian drinkers

The impact of depressive symptoms on ART initiation among Russian HIV-infected heavy drinkers enrolled in a secondary HIV prevention trial (HERMITAGE) was examined. We assessed 133 participants eligible for ART initiation (i.e., CD4 count <350 cells/μl) who were not on ART at baseline. Depressive symptom severity and ART use were measured at baseline, 6- and 12-months. Association between depressive symptoms and subsequent ART initiation was evaluated using GEE logistic regression adjusting for gender, past ART use, injection drug use and heavy drinking. Depressive symptom severity was not significantly associated with lower odds of initiating ART. Cognitive depression symptoms were not statistically significant (global p = 0.05); however, those with the highest level of severity had an AOR of 0.25 (95 % CI 0.09-0.71) for delayed ART initiation. Although the effect of depression severity was not significant, findings suggest a potential role of cognitive depression symptoms in decisions to initiate ART in this population.

Excess burden of depression among HIV-infected persons receiving medical care in the united states: data from the medical monitoring project and the behavioral risk factor surveillance system

Background

With increased life expectancy for HIV-infected persons, there is concern regarding comorbid depression because of its common occurrence and association with behaviors that may facilitate HIV transmission. Our objectives were to estimate the prevalence of current depression among HIV-infected persons receiving care and assess the burden of major depression, relative to that in the general population.

Methods and Findings

We used data from the Medical Monitoring Project (MMP) and the Behavioral Risk Factors Surveillance System (BRFSS). The eight-item Patient Health Questionnaire was used to identify depression. To assess the burden of major depression among HIV-infected persons receiving care, we compared the prevalence of current major depression between the MMP and BRFSS populations using stratified analyses that simultaneously controlled for gender and, in turn, each of the potentially confounding demographic factors of age, race/ethnicity, education, and income. Each unadjusted comparison was summarized as a prevalence ratio (PR), and each of the adjusted comparisons was summarized as a standardized prevalence ratio (SPR). Among HIV-infected persons receiving care, the prevalence of a current episode of major depression and other depression, respectively, was 12.4% (95% CI: 11.2, 13.7) and 13.2% (95% CI: 12.0%, 14.4%). Overall, the PR comparing the prevalence of current major depression between HIV-infected persons receiving care and the general population was 3.1. When controlling for gender and each of the factors age, race/ethnicity, and education, the SPR (3.3, 3.0, and 2.9, respectively) was similar to the PR. However, when controlling for gender and annual household income, the SPR decreased to 1.5.

Conclusions

Depression remains a common comorbidity among HIV-infected persons. The overall excess burden among HIV-infected persons receiving care is about three-times that among the general population and is associated with differences in annual household income between the two populations. Relevant efforts are needed to reduce this burden.

HIV and depression in Eastern Nigeria: the role of HIV-related stigma

To examine the prevalence of depression among HIV-positive patients in Eastern Nigeria and to explore its association with HIV-related stigma. One hundred and five patients with a diagnosis of HIV attending HIV clinics in Eastern Nigeria completed a questionnaire consisting of demographic and health background, the Patients Health Questionnaire (to measure depression) and the Berger HIV stigma scale. As many as 33.3% of participants were considered depressed. Depression was positively correlated with overall stigma score with further analysis finding a positive correlation with all four subscales of the questionnaire (personalised stigma, disclosure, negative self-image and public attitudes). Individuals experiencing more side effects of HIV treatment were also rated as more depressed. A regression analysis found that negative self-image and number of treatment side effects were significant predictors of depression. Depression is positively associated with HIV-related stigma in this sample in Eastern Nigeria. As both stigma and depression have been shown to have a negative impact on quality of life for those with HIV, health professionals working to support them should be aware of the impact of stigma on risk of depression. Screening for both HIV-related stigma and depression would be an important intervention to promote both physical and psychological well-being amongst HIV-positive patients in Eastern Nigeria.

The evolutionary significance of depression in Pathogen Host Defense (PATHOS-D)

Given the manifold ways that depression impairs Darwinian fitness, the persistence in the human genome of risk alleles for the disorder remains a much debated mystery. Evolutionary theories that view depressive symptoms as adaptive fail to provide parsimonious explanations for why even mild depressive symptoms impair fitness-relevant social functioning, whereas theories that suggest that depression is maladaptive fail to account for the high prevalence of depression risk alleles in human populations. These limitations warrant novel explanations for the origin and persistence of depression risk alleles. Accordingly, studies on risk alleles for depression were identified using PubMed and Ovid MEDLINE to examine data supporting the hypothesis that risk alleles for depression originated and have been retained in the human genome because these alleles promote pathogen host defense, which includes an integrated suite of immunological and behavioral responses to infection. Depression risk alleles identified by both candidate gene and genome-wide association study (GWAS) methodologies were found to be regularly associated with immune responses to infection that were likely to enhance survival in the ancestral environment. Moreover, data support the role of specific depressive symptoms in pathogen host defense including hyperthermia, reduced bodily iron stores, conservation/withdrawal behavior, hypervigilance and anorexia. By shifting the adaptive context of depression risk alleles from relations with conspecifics to relations with the microbial world, the Pathogen Host Defense (PATHOS-D) hypothesis provides a novel explanation for how depression can be nonadaptive in the social realm, whereas its risk alleles are nonetheless represented at prevalence rates that bespeak an adaptive function.

Mental health outcomes in HIV and childhood maltreatment: a systematic review

BACKGROUND

High rates of childhood maltreatment have been documented in HIV-positive men and women. In addition, mental disorders are highly prevalent in both HIV-infected individuals and victims of childhood maltreatment. However, there is a paucity of research investigating the mental health outcomes associated with childhood maltreatment in the context of HIV infection. The present systematic review assessed mental health outcomes in HIV-positive individuals who were victims of childhood maltreatment.

METHODS

A systematic search of all retrospective, prospective, or clinical trial studies assessing mental health outcomes associated with HIV and childhood maltreatment. The following online databases were searched on 25-31 August 2010: PubMed, Social Science Citation Index, and the Cochrane Library (the Cochrane Central Register of Controlled Trials and the Cochrane Developmental, Psychosocial and Learning Problems, HIV/AIDS, and Depression, Anxiety and Neurosis registers).

RESULTS

We identified 34 studies suitable for inclusion. A total of 14,935 participants were included in these studies. A variety of mixed mental health outcomes were reported. The most commonly reported psychiatric disorders among HIV-positive individuals with a history of childhood maltreatment included: substance abuse, major depressive disorder, and posttraumatic stress disorder. An association between childhood maltreatment and poor adherence to antiretroviral regimens was also reported in some studies.

CONCLUSION

A broad range of adult psychopathology has been reported in studies of HIV-infected individuals with a history of childhood maltreatment. However, a direct causal link cannot be well established. Longer term assessment will better delineate the nature, severity, and temporal relationship of childhood maltreatment to mental health outcomes.

HIV symptom distress and anxiety sensitivity in relation to panic, social anxiety, and depression symptoms among HIV-positive adults

Although past work has documented relations between HIV/AIDS and negative affective symptoms and disorders, empirical work has only just begun to address explanatory processes that may underlie these associations. The current investigation sought to test the main and interactive effects of HIV symptom distress and anxiety sensitivity in relation to symptoms of panic disorder (PD), social anxiety disorder (SA), and depression among people with HIV/AIDS. Participants were 164 adults with HIV/AIDS (17.1% women; mean age, 48.40) recruited from AIDS service organizations (ASOs) in Vermont/New Hampshire and New York City. The sample identified as 40.9% white/Caucasian, 31.1% black, 22.0% Hispanic, and 6.1% mixed/other; with more than half (56.7%) reporting an annual income less than or equal to $10,000. Both men and women reported unprotected sex with men as the primary route of HIV transmission (64.4% and 50%, respectively). HIV symptom distress and anxiety sensitivity (AS) were significantly positively related to PD, SA, and depression symptoms. As predicted, there was a significant interaction between HIV symptom distress and anxiety sensitivity in terms of PD and SA symptoms, but not depressive symptoms. Results suggest that anxiety sensitivity and HIV symptom distress are clinically relevant factors to consider in terms of anxiety and depression among people living with HIV/AIDS. It may be important to evaluate these factors among patients with HIV/AIDS to identify individuals who may be at a particularly high risk for anxiety and depression problems. Limitations included recruitment from ASOs, cross-sectional self-report data, and lack of a clinical diagnostic assessment.

Once daily dosing improves adherence to antiretroviral therapy

We studied the association of once-daily dosing with self-reported adherence among participants of the Ontario Cohort Study who were currently taking ART and who had completed a 90-min interviewer-administered questionnaire. Suboptimal adherence was defined as missing ≥1 dose of ART in the 4 days prior to the interview. Participants (n = 779) were 85% male, 69% men having sex with men, 67% white, median age 48 years (IQR 42-54), median years of ART 9 (IQR 5-13) and median CD4 count 463 cells/mm(3) (IQR 320-638). Fifteen percent of participants reported suboptimal adherence in the 4 days prior to the interview. In a multivariable logistic regression model, participants on once daily regimens were half as likely to miss a dose during the 4 days prior to the interview. Other independent correlates of suboptimal adherence were younger age, lower positive social interaction and increased frequency of consuming > 6 alcoholic drinks on one occasion.

Impact of childhood trauma on functionality and quality of life in HIV-infected women

BACKGROUND

While there are many published studies on HIV and functional limitations, there are few in the context of early abuse and its impact on functionality and Quality of Life (QoL) in HIV.

METHODS

The present study focused on HIV in the context of childhood trauma and its impact on functionality and Quality of Life (QoL) by evaluating 85 HIV-positive (48 with childhood trauma and 37 without) and 52 HIV-negative (21 with childhood trauma and 31 without) South African women infected with Clade C HIV. QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Patient's Assessment of Own Functioning Inventory (PAOFI), the Activities of Daily Living (ADL) scale and the Sheehan Disability Scale (SDS). Furthermore, participants were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Childhood Trauma Questionnaire (CTQ).

RESULTS

Subjects had a mean age of 30.1 years. After controlling for age, level of education and CES-D scores, analysis of covariance (ANCOVA) demonstrated significant individual effects of HIV status and childhood trauma on self-reported QoL. No significant interactional effects were evident. Functional limitation was, however, negatively correlated with CD4 lymphocyte count.

CONCLUSIONS

In assessing QoL in HIV-infected women, we were able to demonstrate the impact of childhood trauma on functional limitations in HIV.

Alcohol consumption and depressive symptoms over time: a longitudinal study of patients with and without HIV infection

BACKGROUND

The impact of alcohol consumption on depressive symptoms over time among patients who do not meet criteria for alcohol abuse or dependence is not known.

OBJECTIVE

To evaluate the impact of varying levels of alcohol consumption on depressive symptoms over time in patients with and without HIV infection.

DESIGN

We used data from the Veterans Aging Cohort Study (VACS). We used generalized estimating equation models to assess the association of alcohol-related categories, as a fixed effect, on the time-varying outcome of depressive symptoms.

PARTICIPANTS

VACS is a prospectively enrolled cohort study of HIV-infected patients and age-, race- and site-matched HIV uninfected patients.

MAIN MEASURES

Hazardous, binge drinking, alcohol abuse and alcohol dependence were defined using standard criteria. Depressive symptoms were measured by the Patient Health Questionnaire (PHQ-9).

KEY RESULTS

Among the 2446 patients, 19% reported past but not current alcohol use, 50% non-hazardous drinking, 8% hazardous drinking, 14% binge drinking, and 10% met criteria for alcohol or dependence. At baseline, depressive symptoms were higher in hazardous and binge drinkers than in past and non-hazardous drinkers (OR=2.65; CI=1.50/4.69; p<.001) and similar to those with abuse or dependence. There was no difference in the association between alcohol-related category and depressive symptoms by HIV status (OR=0.99; CI=.83/1.18; p=.88). Hazardous drinkers were 2.53 (95% CI=1.34/4.81) times and binge drinkers were 2.14 (95% CI=1.49/3.07) times more likely to meet criteria for depression when compared to non-hazardous drinkers. The associations between alcohol consumption and depressive symptoms persisted over three years and were responsive to changes in alcohol-related categories.

CONCLUSIONS

HIV-infected and HIV-uninfected hazardous and binge drinkers have depressive symptoms that are more severe than non-hazardous and non-drinkers and similar to those with alcohol abuse or dependence. Patients who switch to a higher or lower level of drinking experience a similar alteration in their depressive symptoms. Interventions to decrease unhealthy alcohol consumption may improve depressive symptoms.

Emotional support and gender in people living with HIV: effects on psychological well-being

Current research indicates that emotional support is strongly associated with physical and psychological adjustment in persons living with HIV/AIDS. While gender- differences in health and health behaviors of HIV positive patients are well studied, less is known about how men and women living with HIV/AIDS may differentially perceive and integrate support into their lives, and how it subsequently affects their psychological well-being. This cross-sectional study examines how emotional support received from partners and family/friends and gender explains psychological well-being (i.e., stress, depression, anxiety) in a sample of 409 partnered European HIV positive individuals. We hypothesized that gender would modify the associations between support and psychological well-being such that men would benefit more from partner support whereas women would benefit more from family/friend support. Results revealed that regardless of the source of support, men's well-being was more positively influenced by support than was women's well-being. Women's difficulties in receiving emotional support may have deleterious effects on their psychological well-being.

Disruption of emotion and conflict processing in HIV infection with and without alcoholism comorbidity

Alcoholism and HIV-1 infection each affect components of selective attention and cognitive control that may contribute to deficits in emotion processing based on closely interacting fronto-parietal attention and frontal-subcortical emotion systems. Here, we investigated whether patients with alcoholism, HIV-1 infection, or both diseases have greater difficulty than healthy controls in resolving conflict from emotional words with different valences. Accordingly, patients with alcoholism (ALC, n = 20), HIV-1 infection (HIV, n = 20), ALC + HIV comorbidity (n = 22), and controls (CTL, n = 16) performed an emotional Stroop Match-to-Sample task, which assessed the contribution of emotion (happy, angry) to cognitive control (Stroop conflict processing). ALC + HIV showed greater Stroop effects than HIV, ALC, or CTL for negative (ANGRY) but not for positive (HAPPY) words, and also when the cue color did not match the Stroop stimulus color; the comorbid group performed similarly to the others when cue and word colors matched. Furthermore, emotionally salient face cues prolonged color-matching responses in all groups. HIV alone, compared with the other three groups, showed disproportionately slowed color-matching time when trials featured angry faces. The enhanced Stroop effects prominent in ALC + HIV suggest difficulty in exercising attentional top-down control on processes that consume attentional capacity, especially when cognitive effort is required to ignore negative emotions.

Affective and behavioural reactions to positive and negative health-related social control in HIV+men

We examined associations between the receipt of positive and negative health-related social control (i.e. influence) from a primary network member, affective and behavioural reactions (i.e. behaviour change) to social control, and psychosocial well-being in a cross-sectional study of 91 HIV+ men living with HIV (MLWH). Receiving positive control was associated with more self-care behaviours, more active coping efforts, and fewer depressive symptoms. In contrast, receiving negative control was associated with fewer self-care behaviours and more depressive symptoms. Negative affective reactions to control mediated the associations between positive and negative control and depressive symptoms, and between positive control and active coping efforts. Behaviour change only mediated the association between positive control and self-care behaviours. Post-hoc analyses further revealed that men who were not at risk for clinical depression engaged in more behaviour change as a result of receiving negative control. Social control that elicits behaviour change and does not arouse negative affect is effective in promoting better self-care behaviours and psychosocial well-being in MLWH.

Prospective, randomized, two-arm controlled study to evaluate two interventions to improve adherence to antiretroviral therapy in Spain

CONTEXT

Proper adherence is essential to obtain the desired results of antiretroviral therapy; thus, new interventional strategies for this purpose must be sought.

OBJECTIVE

Comparison of 2 interventions, one conducted by a health professional and the other by a peer (patient on antiretroviral therapy), to improve adherence to antiretroviral therapy.

DESIGN AND SETTING

In 2003, a randomized, concurrent, follow-up study was conducted at 3 hospitals.

PARTICIPANTS

Patients were recruited consecutively at infectious disease visits scheduled to monitor their disease from May to September 2003. A sealed envelope was used to assign patients to each intervention group. A previous phase was conducted to unify data collection, and the intervention consisted of 4 visits at weeks 0, 8, 16, and 24.

RESULTS

Among the 240 patients included, 198 completed follow-up, and in 11 of these, treatment was interrupted at the doctor's decision. At baseline, 46.8% were classified as adherent. Multilevel analysis showed that as the visits progressed, the probability of adhering to treatment increased (OR 1.23; P<.01). Although differences were not significant, the group treated by a peer showed better results than the group treated by a health professional (OR 1.60; P=0.25). A lower probability of antiretroviral adherence was observed in patients receiving a drug combination including a protease inhibitor (OR 0.27; P<0.01) and in those with psychological distress (OR 0.44; P=0.03). Patients with a higher score on the physical quality of life index (OR 1.05; P<0.01) presented a higher probability of adherence.

CONCLUSIONS

The psychoeducational intervention studied is viable and effective for improving antiretroviral adherence. When the intervention is conducted by a peer the results are at least as good as those obtained by a health professional, and this implies cost-saving for the health system.

Risk and protective factors in association with mental health problems among people living with HIV who were former plasma/blood donors in rural China

A random sample of 271 people living with HIV (PLWH) who were former plasma/blood donors and a convenience sample of 67 HIV negative villagers were anonymously interviewed. Compared with the non-PLWH, PLWH reported higher prevalence of symptoms of depression (adjusted OR = 2.53, p=0.001), anxiety (adjusted OR = 1.85, p=0.04), and stress (adjusted OR = 1.77, p=0.06). Of the PLWH respondents, 81.7% received Highly Active Antiretroviral Therapy (HAART); 32.1% of whom reported some side effects. Respectively 13.7%, 37.4%, and 38.4% PLWH perceived discrimination from their family members, relatives/friends, and neighbors. Absence of HAART, poor physical function, perceived discrimination from relatives and friends, and low level of resilience were associated with depression (stepwise regression; beta = - 0.28-0.17, R-square = 0.22), anxiety and stress (R-square = 0.32 and 0.16, respectively). The majority of respondents (70.1%) desired group intervention as a means for providing psychological support services. Relevant programs should both remove risk factors (e.g., absence of medical treatment, HIV-related discrimination) and promote protective factors (e.g., resilience). Support group is one of the potentially useful approaches to provide psychological support services.

The interaction of mindful-based attention and awareness and disengagement coping with HIV/AIDS-related stigma in regard to concurrent anxiety and depressive symptoms among adults with HIV/AIDS

This investigation examined the interaction of disengagement coping with HIV/AIDS-related stigma and mindful-based attention and awareness in regard to anxiety and depressive symptoms among people with HIV/AIDS. There was a significant interaction in regard to anxiety symptoms. Higher levels of disengagement coping paired with lower levels of mindful-based attention and awareness was related to the greatest degrees of anxiety symptoms, while lower levels of disengagement coping paired with higher levels of mindful-based attention and awareness was related to the lowest levels of anxiety symptoms. Although the interaction for depressive symptoms was not significant, a similar pattern of results was observed.

Adverse psychosocial factors predict poorer prognosis in HIV disease: a meta-analytic review of prospective investigations

There is a growing epidemiological literature focusing on the association between psychosocial stress and human immunodeficiency virus (HIV) disease progression or acquired immunodeficiency syndrome (AIDS), but inconsistent findings have been published. We aimed to quantify the association between adverse psychosocial factors and HIV disease progression. We searched Medline; PsycINFO; Web of Science; PubMed up to 19 January 2009, and included population studies with a prospective design that investigated associations between adverse psychosocial factors and HIV disease progression or AIDS. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. The overall meta-analysis examined 36 articles including 100 psychosocial and disease related relationships. It exhibited a small, but robust positive association between adverse psychosocial factors and HIV progression (correlation coefficient as combined size effect 0.059, 95% confidence interval 0.043-0.074, p<0.001). Notably, sensitivity analyses showed that personality types or coping styles and psychological distress were more strongly associated with greater HIV disease progression than stress stimuli per se, and that all of the immunological and clinical outcome indicators (acquired immunodeficiency syndrome stage, CD4+ T-cell decline, acquired immunodeficiency syndrome diagnosis, acquired immunodeficiency syndrome mortality, and human immunodeficiency virus disease or acquired immunodeficiency syndrome symptoms) except for viral load exhibited detrimental effects by adverse psychosocial factors. In conclusion, the current review reveals a robust relationship between adverse psychosocial factors and HIV disease progression. Furthermore, there would appear to be some evidence for particular psychosocial factors to be most strongly associated with HIV disease progression.

CD4 count and physical symptoms among urban African American mothers with HIV: an examination of the role of optimism and depressive symptoms

The current study examined the link between immune functioning (CD4 count) and physical symptoms, as well as the moderating role of optimism and depressive symptoms, in a sample of 99 low income, inner city African American women with HIV. Although there was no main effect of CD4 count on physical symptoms, depressive symptoms moderated the association between CD4 count and physical symptoms. More compromised immune functioning (lower CD4 count) was associated with more physical symptoms under conditions of higher levels of depressive symptoms, but not lower levels of depressive symptoms. This finding was observed using both a self-report measure and a clinician-rating of women's depressive symptoms. There were no main or interactive effects for optimism. Clinical implications and future research directions are presented.

The impact of alcohol use on depressive symptoms in human immunodeficiency virus-infected patients

AIMS

To examine the impact of alcohol use on depressive symptoms in human immunodeficiency virus (HIV)-infected patients.

DESIGN

Data were collected at 6-month intervals and analyzed to evaluate the association between alcohol dependence and consumption on depressive symptoms using longitudinal mixed-effects regression models controlling for specified covariates.

MEASUREMENTS

The two independent variables were current alcohol dependence assessed using the Composite International Diagnostic Interview (CIDI) and past month consumption (heavy versus not heavy drinking) using a validated calendar-based method. The primary outcome was depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale (CES-D).

PARTICIPANTS

HIV-infected adults with current or past alcohol problems.

FINDINGS

Alcohol dependence and heavy alcohol use were significantly associated with higher CES-D scores in unadjusted models. In adjusted analyses, the association of current alcohol dependence persisted [mean difference in CES-D was 3.49 for dependence versus non-dependence; 95% confidence interval (CI): 1.76-5.22]; however, the effect of heavy drinking was no longer statistically significant (mean difference in CES-D was 1.04 for heavy versus not heavy drinking; 95% CI: -0.24-2.32).

CONCLUSIONS

Alcohol use is associated with more depressive symptoms in HIV-infected patients with alcohol problems. This association remains significant after adjusting for potential confounders only when alcohol use meets the criteria for alcohol dependence.

Quality of life and immune activation in patients with HIV-infection

Depression and impaired quality of life (QoL) are frequently observed in patients suffering from HIV-infection. As an enhanced degradation of the serotonin precursor tryptophan is well documented in HIV-infected patients, disturbances in tryptophan metabolism may be causally linked to HIV-related depression. In this study, the relationship between QoL, depression, various laboratory parameters and tryptophan metabolism was investigated. To estimate QoL and mood, 152 HIV-infected patients (classified according to CDC-criteria) were requested to complete the following psychological questionnaires: BDI and MQoL-HIV. Disease progression was monitored by determination of viral load (VL), CD4(+) cell counts, haemoglobin and urinary/plasma neopterin, tryptophan and kynurenine concentrations. Increasing VL, decreasing CD4(+) cell counts, and enhanced tryptophan degradation reflected disease progression. Forty-one patients presented with mild, 22 with moderate and 14 with severe depression. BDI and MQoL scores were associated strongly with each other (rs=-0.838; p<0.001). Patients without depression had significantly lower plasma neopterin concentrations, higher CD4(+) cell counts and haemoglobin concentrations and better QoL scores (all p<0.01) than depressive patients. Furthermore, they showed lower rates of tryptophan degradation (p<0.05). Significant associations were observed between tryptophan degradation and immune activation. Haemoglobin and viral load were predictive for impaired QoL, while high urinary neopterin concentrations and low haemoglobin were the best predictors for depression. In HIV-infected patients, depressive mood and impaired QoL appear to be related to clinical parameters like immune activation, haemoglobin values and viral load.

The effect of Depressive Symptoms at ART Initiation on HIV Clinical Progression and Mortality: Implications in Clinical Practice

Background

Depression is common in HIV-infected patients receiving antiretroviral therapy. However, longitudinal studies addressing the role that depression might play in HIV clinical progression and mortality remain rare. This is especially true for those studies that also consider the possible confounding influence of patient's adherence to treatment.

Methods

The ANRS CO-8 APROCO-COPILOTE cohort study enrolled 1,281 individuals at the initiation of a protease-inhibitor-containing regimen between 1997 and 1999. Adherence, depressive symptoms and other psychosocial factors were measured using self-administered questionnaires. Predictors of progression to AIDS or death were studied using Cox models.

Results

Out of 1,028 individuals eligible for the present analysis, 92 individuals either died or had an AIDS-defining event during a median follow up of 54 months. At baseline, 377 individuals (41%) reported depressive symptoms and 124 (12%) reported non-adherence at month 4. Depressive symptoms at baseline were associated with progression (hazard ratio [HR] 2.1; P=0.001). Despite the association between depressive symptoms and non-adherence, depressive symptoms remained a predictor of clinical progression (adjusted HR [aHR] [95% confidence interval (CI)] 1.6 [1.0–2.5]) after adjustment for several factors: initial non-adherence (aHR [95% CI] 2.0 [1.1–3.6]), having a steady partner (aHR [95% CI] 0.5 [0.3–0.7]), older age (aHR [95% CI] 1.40 [1.12–1.74] per 10-year increment), HIV clinical stage C (aHR [95% CI] 2.5 [1.6–4.0]), plasma HIV RNA ≥100,000 copies/ml (aHR [95% CI] 1.7 [1.1–2.87]) and more than 8 years since HIV diagnosis (aHR [95% CI] 1.8 [1.1–2.8]).

Conclusion

Depressive symptoms and non-adherence are independent predictors of HIV clinical progression and mortality. Screening and appropriate treatment of depressive symptoms at antiretroviral treatment initiation should be included in the standard care of HIV-infected patients.

Is AIDS chronic or terminal? The perceptions of persons living with AIDS and their informal support partners

Viewed as a terminal disease just a decade ago, HIV/AIDS is now often characterized as a chronic yet manageable disease. The goal of this study is to assess the perceptions of the course of the disease among persons living with AIDS and their informal support partners and to identify the themes that distinguish the differing perceptions of the epidemic. The findings from this research reveal that 41% of persons living with AIDS and 39% of their informal support partners perceive AIDS as chronic. By contrast, 37% of persons living with AIDS and 39% of the informal support partners perceive AIDS to be terminal rather than chronic. Among persons living with HIV/AIDS, those with lower levels of education and higher levels of perceived race-based discrimination were significantly more likely to view AIDS as a terminal rather than chronic condition. In addition, informal support partners in poor health were significantly more likely than others to view AIDS as terminal rather than chronic. Content analyses of the qualitative data revealed five broad themes related to the specific perceptions of AIDS, including medications, personal experience, cure, time/eventuality and education. The implications of these findings are discussed.

Diminished quality of life in patients with cancer correlates with tryptophan degradation

PURPOSE

Quality of life (QoL) is frequently impaired in patients suffering from malignant disease. Disturbed metabolism of neurotransmitter serotonin might be crucially involved, and serotonin-precursor tryptophan is degraded during pro-inflammatory immune response. In this study, we compared QoL and fatigue self-rating scores of patients with various types of malignancy with tryptophan metabolic changes and immune activation status.

METHODS

Venous blood was collected from 146 patients with gastrointestinal tumors (n = 43), hematological malignancy (n = 40), gynecological neoplasms (n = 26), lung cancer (n = 20) and from tumors of other localization (n = 17).

RESULTS

QoL was significantly reduced in patients suffering from progressive tumor disease in comparison to stable or remitting disease, also feeling of fatigue was increased (both P < 0.001). Serum tryptophan concentrations were lower in patients with progressive disease (P < 0.01), and decreased tryptophan concentrations were related to decreased QoL (r(s) = 0.256, P < 0.01) and increased fatigue (r(s) = -0.179; P < 0.05). Concentrations of tryptophan and kynurenine and the kynurenine to tryptophan ratio were predictive for impaired QoL and increased fatigue in univariate regression analysis, in multivariate analysis higher ESR and neopterin concentration in combination with stage of disease predicted QoL deterioration.

CONCLUSIONS

Results suggest that immune-mediated tryptophan degradation may contribute to cancer-induced QoL deterioration.

Lymphocyte subsets and viral load in male AIDS patients with major depression: naturalistic study

This study investigated the relationships between lymphocyte subsets and viral load in AIDS patients with and without major depression. During a 7-year period, a total of 60 male hospitalized AIDS patients were recruited in this study. The diagnosis of major depression in patients was made by the same psychiatrist according to the 4th edition of the Diagnostic and Statistical Manual for Mental Disorders criteria. All patients had data for CD4, CD8 and CD4/CD8, and only 42 patients had viral load data. Of 60 AIDS patients, 32 patients had received highly active antiretroviral therapy and received subsequent assessment of lymphocyte cell counts 1 month later. Using ancova with age adjustment, the authors found that patients with major depression (n = 22) had significantly lower CD8 cell counts than patients without major depression (n = 38). However, CD4 cell counts and CD4/CD8 ratios were not significantly different between these two groups. In addition, there was no significant difference in viral load between patients with major depression (n = 16) and patients without major depression (n = 26). Of 32 patients received highly active antiretroviral therapy, 14 patients with an antidepressant (e.g. fluoxetine 20 mg/day) had significantly decreased CD4 and not CD8 cell counts and significantly reduced CD4/CD8 ratios during a period of 1 month. In conclusion, these results suggest that AIDS patients with major depression had significantly lower CD8 cell counts and might have a more severe inflammation/immunity reaction than patients without major depression.

Impacto de los factores demográficos y psicosociales en la no adherencia a los fármacos antirretrovirales

BACKGROUND AND OBJECTIVE

Antiretroviral efficacy is closely related to the degree of adherence. The aim of this study is to assess the association between psychosocial and demographic variables and adherence to antiretroviral treatment.

PATIENTS AND METHODS

A cross-sectional survey of 320 patients under antiretroviral treatment was conducted in four Andalusian hospitals, using a semi-structured questionnaire given by health care professionals.

RESULTS

Median age was 39.7 years. Nearly 12% of the sample was considered non-compliant to antiretroviral treatment. An interaction was observed between psychological morbidity and mental health quality of life scores. Among patients who presented psychological morbidity, a higher mental quality of life score was associated with a lower risk of non-compliance (P = 0.04). This association was not found among patients without psychological morbidity. Older age, homosexual or bisexual status and the use of injecting drugs for a shorter period of time was associated with non-compliance.

CONCLUSIONS

Demographic and psychological factors have an influence on adherence to antiretroviral treatment.

Neurologic and psychiatric complications of antiretroviral agents

Advances in highly active antiretroviral therapy (HAART) aim to improve the efficacy of HIV drugs as well as the quality of life in HIV-infected patients. Neurologic and psychologic disturbances that occur because of HIV disease and therapy are of great concern, and because they can overlap and are often difficult to distinguish, their pathogenesis is not clearly understood. Furthermore, these complications can lead to decreased adherence, thereby interfering with treatment outcomes. Antiretrovirals, including nonnucleoside reverse transcriptase inhibitors, can penetrate the central nervous system (CNS) and suppress viral replication, but they can also exacerbate CNS side effects and neuropsychiatric symptoms. When deciding which HAART drug combination is most appropriate for a patient, clinicians must consider the individual's risk of CNS complications together with the efficacy of the specific HAART regimen.