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The effect of depressive symptoms at ART initiation on HIV clinical progression and mortality: implications in clinical practice.
Antivir Ther. 2007; 12(7):1067-74.AT

Abstract

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 nonadherence, 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 > or = 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.

Authors+Show Affiliations

INSERM U379, Marseilles, France. villes@marseille.inserm.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18018765

Citation

Villes, Virginie, et al. "The Effect of Depressive Symptoms at ART Initiation On HIV Clinical Progression and Mortality: Implications in Clinical Practice." Antiviral Therapy, vol. 12, no. 7, 2007, pp. 1067-74.
Villes V, Spire B, Lewden C, et al. The effect of depressive symptoms at ART initiation on HIV clinical progression and mortality: implications in clinical practice. Antivir Ther. 2007;12(7):1067-74.
Villes, V., Spire, B., Lewden, C., Perronne, C., Besnier, J. M., Garré, M., Chêne, G., Leport, C., Carrieri, M. P., & Le Moings, V. (2007). The effect of depressive symptoms at ART initiation on HIV clinical progression and mortality: implications in clinical practice. Antiviral Therapy, 12(7), 1067-74.
Villes V, et al. The Effect of Depressive Symptoms at ART Initiation On HIV Clinical Progression and Mortality: Implications in Clinical Practice. Antivir Ther. 2007;12(7):1067-74. PubMed PMID: 18018765.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of depressive symptoms at ART initiation on HIV clinical progression and mortality: implications in clinical practice. AU - Villes,Virginie, AU - Spire,Bruno, AU - Lewden,Charlotte, AU - Perronne,Christian, AU - Besnier,Jean-Marc, AU - Garré,Michel, AU - Chêne,Geneviève, AU - Leport,Catherine, AU - Carrieri,Maria Patrizia, AU - Le Moings,Vincent, AU - ,, PY - 2007/11/21/pubmed PY - 2007/12/14/medline PY - 2007/11/21/entrez SP - 1067 EP - 74 JF - Antiviral therapy JO - Antivir Ther VL - 12 IS - 7 N2 - 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 nonadherence, 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 > or = 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. SN - 1359-6535 UR - https://www.unboundmedicine.com/medline/citation/18018765/The_effect_of_depressive_symptoms_at_ART_initiation_on_HIV_clinical_progression_and_mortality:_implications_in_clinical_practice_ L2 - http://www.diseaseinfosearch.org/result/9735 DB - PRIME DP - Unbound Medicine ER -