HIV patients with long-term depression may be twice as likely to die from any cause than those without the mental health illness, a new study warns. Researchers found that the proportion of time HIV patients spend depressed is directly related to the likelihood of missing doctor appointments and how well their infection is suppressed.
Prior research has found depression is prevalent among those living with the virus.
The study, conducted by researchers at the University of North Carolina, Chapel Hill, is the latest to examine how mood can impact the treatment outcome of HIV patients.
As of 2015, an estimated 1.1 million people in the US were living with HIV, according to the Centers for Disease Control and Prevention.
Between 20 and 40 percent of people living with the virus also have depression, according to Dr Brian Pence, lead author of the current study.
‘If we can shorten an HIV patient’s exposure to depression by picking it up early and treating it well using evidence based protocols, we can make a difference in their outcomes,’ he said.
For the study, researchers, led by Dr Pence analyzed the records of 5,927 patients receiving HIV primary care across the country. Each patient was followed for one to six years between September 2005 and August 2015.
All participants had two or more consecutive screenings for depression within a year.
Half of the patients spent less than 34 months of the 10-year-study depressed, while 3.6 percent of them were depressed during the whole study. Thirty-two percent of the patients reported no depression.
Researchers found that the amount of time patients spent depressed was tied to an increase in risk of them missing appointments for HIV primary care and of having detectable virus in blood tests – meaning the virus was no longer suppressed and could spread easily, and of death from any cause.
This is alarming since previous studies have linked missed HIV clinic appointments to poorer treatment outcomes.
For every 25 percent increase in days spent depressed, there was an eight percent increase in missed appointments, a five percent increase in likelihood of having detectable viral load and a 19 percent rise in mortality risk.
For the patients who were depressed throughout the whole study, that translated to a 37 percent higher risk of missing appointments and 23 percent risk of treatment failure.
This isn’t the first study to link mood disorder to HIV treatment outcomes.
A 2017 study conducted by Northwestern University found happy HIV patients were less likely to develop AIDS and their virus was less infectious.
Furthermore, a study published in 2010 found that HIV patients who missed three or more medical visits had a two-fold increased risk of lower CD4 count (which indicates the virus is more advanced) by six months and had an increased risk of death.
Experts say major depression is the most common mental health disorder among HIV patients.
Research published in a 2014 issue of Psychiatry and Clinical Neurosciences found major depression affects up to 81 percent of HIV patients. It also revealed they are two to seven times more likely to have depressive symptoms.
‘We need to find better ways to integrate mental health care into chronic disease care . . . There’s good evidence that primary care providers and non-specialists can be as effective as psychiatrists using assertive dosing schedules,’ Dr Pence said.
He said more research is needed to promptly identify and appropriately treat depression among adults living with HIV and to understand the effect of such protocols.
According to the CDC, about one out of every six adults will have depression at some time in their life. Symptoms of this mood disorder include feelings of hopelessness, suicidal thoughts, and not wanting to do activities that used to be fun.
‘What’s useful and important about this study is the fact that caring for people with HIV requires more than getting drugs into their bodies to control their disease,’ said Judith D. Auerbach, a researcher with the Center for AIDS Prevention Studies/Division of Prevention Sciences in University of California, San Francisco School of Medicine, who was not involved in the research
‘I think this problem is transferable to other chronic diseases and disorders,’ she said.