Depressive Symptoms and AIDS-Related Mortality Among a Multisite Cohort of HIV-Positive Women

The researchers examined associations between depressive symptoms and AIDS-related mortality after controlling for antiretroviral therapy use, clinical indicators, and demographic factors. Between October 1994 and November 1995, 2,059 HIV-seropositive women were enrolled in the Women's Interagency HIV Study at six medical and university consortia sites nationwide: Brooklyn and Bronx, N.Y.; Chicago, Ill.; Los Angeles and San Francisco, Calif.; and Washington, D.C. For the next 7.5 years, participants completed WIHS study visits at six-month intervals. Specific responses to items in the interview protocol prompted interviewers to offer respondents referrals to medical or psychosocial services such as gynecologic care or substance-abuse treatment.

Of the 2,059 women participating in WIHS, the researchers chose 1,716 HIV-positive women for the study. Two-fifths of participants reported illicit drug use before baseline, and 39 percent reported using drugs during the study. Baseline CD4 counts were below 200 for 25 percent of the women, and 68 percent had viral loads greater than 4,000. Forty-nine percent had used a highly active antiretroviral therapy regimen for one or more years, and 14 percent used a non-HAART combination therapy for one year or more. Five percent reported using monotherapy for one year, and 32 percent reported no antiretroviral therapy or use of such therapy for less than a year.

The investigators used multivariate Cox and logistic regression analyses to estimate the time to AIDS-related death and severity of depressive symptoms. After controlling for all other factors, (clinical, substance use, and socio-demographic), the researchers found that AIDS-related deaths were more likely among women with chronic depressive symptoms, and that such symptoms were more severe among women in the terminal phases of illness. They found use of mental health services to be associated with reduced mortality.

In addition, the authors found that women on HAART for a year or more were 90 percent less likely to experience AIDS-related mortality, and those on a combination ARV therapy for a year or more were 70 percent less likely to die during the study period. The proportion of women reporting recent depressive symptoms was lowest among participants on HAART.

The findings "suggest that antiretroviral therapy alone does not meet best-practice standards of care for this population, and therapy must be augmented by appropriate and sensitive mental health treatment, particularly as HIV disease progresses. Thus, finding ways to reduce depressive symptoms has the potential not only to prolong life but also to enhance its quality among women who have HIV," the authors concluded.

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