Effects of Depression and Selective Serotonin Reuptake Inhibitor Use on Adherence to Highly Active Antiretroviral Therapy and on Clinical Outcomes in HIV-Infected Patients.

EPIDEMIOLOGY AND SOCIAL SCIENCE

JAIDS Journal of Acquired Immune Deficiency Syndromes. POST AUTHOR CORRECTIONS, 13 December 2007
Horberg, Michael Alan MD, MAS, FACP *; Silverberg, Michael Jonah PHD, MPH *; Hurley, Leo Bartemeier MPH *; Towner, William James MD +; Klein, Daniel Benjamin MD ++; Bersoff-Matcha, Susan MD [S]; Weinberg, Winkler Gabriel MD [//]; Antoniskis, Diana MD [P]; Mogyoros, Miguel MD #; Dodge, Wayne Thomas MD **; Dobrinich, Robert MD ++; Quesenberry, Charles Price PHD *; Kovach, Drew Anthony MD ++++

Abstract:
Objectives: To determine the impact of depression on highly active antiretroviral therapy (HAART) adherence and clinical measures and investigate if selective serotonin reuptake inhibitors (SSRIs) improve these measures.

Design: Retrospective cohort study.

Methods: In 2 large health maintenance organizations, we measured the effects of depression (with and without SSRI use) on adherence and changes in viral and immunologic control among HIV-infected patients starting a new HAART regimen. HAART adherence, HIV RNA levels, and changes in CD4 T-cell counts through 12 months were measured.

Results: A total of 3359 patients were evaluated; 42% had a depression diagnosis, and 15% used SSRIs during HAART. Depression without SSRI use was associated with significantly decreased odds of achieving >=90% adherence to HAART (odds ratio [OR] = 0.81, 95% confidence interval [CI]: 0.70 to 0.98; P = 0.03). Depression was associated with significantly lower odds of an HIV RNA level <500 copies/mL (OR = 0.77, 95% CI: 0.62 to 0.95; P = 0.02). Depressed patients compliant with SSRI medication (>80% adherence to SSRI) had HAART adherence and viral control statistically similar to nondepressed HIV-infected patients taking HAART. Comparing depressed with nondepressed HIV-infected patients, CD4 T-cell responses were statistically similar; among depressed patients, those compliant with SSRI had statistically greater increases in CD4 cell responses.

Conclusions: Depression significantly worsens HAART adherence and HIV viral control. Compliant SSRI use is associated with improved HIV adherence and laboratory parameters.

(C) 2008 Lippincott Williams & Wilkins, Inc.