Treatment of Depression Improves HAART Compliance in HIV-Positive Patients

In a study of over 3000 HIV-infected patients, a diagnosis of depression was associated with poor adherence to highly active antiretroviral therapy (HAART) and poorer virologic control, researchers report in the March 1 issue of the Journal of Acquired Immune Deficiency Syndromes.

If depression was adequately treated, however, adherence levels were similar to those of non-depressed patients, and this resulted in a significant improvement in virologic control.

Dr. Michael Alan Horberg of Kaiser Permanente in Oakland, California and colleagues evaluated depression and its effect on treatment in 3,359 HIV-infected patients starting a new HAART regimen.

Of the total, 42% had a diagnosis of depression, but only 15% used selective serotonin reuptake inhibitors (SSRIs) during HAART.

Dr. Horberg and colleagues found that the odds of achieving 90% or better adherence to HAART were significantly decreased (odds ratio = 0.81) if depression was untreated. Depression was associated with a significantly lower odds of an HIV RNA level less than 500 copies/ml (OR = 0.77).

Depressed patients who had SSRI compliance rates above 80% had HAART adherence rates and viral control that was statistically similar to that of non-depressed HIV-infected subjects.

"Because depression is negatively associated with HAART adherence and with clinical outcome measures for these patients, screening for depression is essential," the Kaiser Permanente team emphasizes.

J Acquir Immune Defic Syndr 2008;47:384-390.