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September 22, 2009

Depression Greatly Impairs Treatment Adherence

People with depression were almost twice as likely to have HIV treatment adherence problems as people who were not depressed, according to an article published online September 17 in the Journal of Acquired Immune Deficiency Syndromes.

Depression has been found in several studies to negatively affect the ability of people living with HIV to take their medications on time and as directed. Not all studies have been able to quantify the effect of depression on adherence, however.

As part of a study on nutrition and HIV, Deborah Kacanek, ScD, from Tufts University School of Medicine in Boston, and her colleagues, asked 225 HIV-positive volunteers about their adherence to antiretroviral (ARV) medication and evaluated them for depression. Twenty-three percent were female and 40 percent were people of color.

None of the participants were found to have depression upon entering the study.  Over time, however, 22 percent
developed depression. Women were more than twice as likely as men to be depressed, which mirrors what is seen in the general population. Also similar to HIV-negative people, those with very low incomes were also more likely to become depressed than people with higher incomes.

In terms of adherence, 45 percent of those who became depressed ended up having poor adherence compared with 25 percent of those who did not become depressed. As has been seen in previous studies, African Americans were also more likely than non-black participants to have adherence challenges. The reasons for this could not be explored in the study, though the authors hypothesize that mistrust of health care providers or of ARV drugs may play a role.

The authors call on providers to regularly screen for depression, especially in people who are having trouble adhering to their HIV treatment regimen. Moreover, the authors write, "It is critical to strengthen referral systems to ensure appropriate treatment… for patients with HIV and depression, not only because it may improve adherence and HAART outcomes, but also because of its potential impact on quality of life overall."

Search: Depression, adherence, Deborah Kacanek, antiretroviral, African-American

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