Treating depression in HIV-positive patients improves treatment adherence and viral outcome, study shows

December 9, 2010 — A team of researchers led by a Harvard School of Public Health (HSPH) postdoctoral research fellow and a Massachusetts General Hospital physician report for the first time that using antidepressant medication to treat depression among HIV-positive individuals not only alleviates suffering from depression but improves adherence to HIV antiretroviral medication and virologic outcomes.

The study appears in the December 2010 issue of the Archives of General Psychiatry.

“The study’s findings provide concrete evidence for why there should be renewed attention to diagnosing and treating depression among people living with HIV/AIDS,” said lead author Alexander Tsai, a psychiatrist and Robert Wood Johnson Health and Society Scholar in the Center for Population and Development Studies at HSPH. “Our study shows that treatment with antidepressant medication can improve HIV antiretroviral therapy adherence and virologic outcomes.”

The study, conducted in San Francisco, involved 158 homeless and “marginally housed” HIV-positive men and women, a population generally considered difficult to treat or study. Many had significant psychosocial impairments such as alcohol and illicit drug use, factors that often result in exclusion from most antidepressant medication randomized trials.

The analysis was done among participants in the Research on Access to Care in the Homeless (REACH) study, observed between April 2002 and August  2007. The average follow-up time was 2.9 years. During the follow-up period, 38 of the 158 participants died and 17 were “lost” to follow-up (moved away, unable to be contacted, etc.). “During the course of the study, participants who were treated with antidepressant medication increased self-reported antiretroviral adherence by 25% and were twice as likely to achieve complete viral suppression,” Tsai said.

Depression is highly prevalent among people living with HIV/AIDS, but it is “massively under diagnosed and undertreated,” Tsai added. One recent national study found more than one-third of people living with HIV in the study screened positive for probable depression. Only half of those who screened positive had been recognized as depressed by their health providers.

Depression also is recognized as strong predictor of non-adherence to medical treatment plans. Depression is associated with worse HIV outcomes, including immunologic decline, progression to AIDS, and AIDS-related mortality, Tsai said. The study findings also may relate to other diseases as depression is known to adversely affect the management and course of conditions such as heart disease and diabetes.

“There is an urgent need for HIV care providers to recognize and treat depression among their patients or to refer their patients to mental health specialists for diagnosis and treatment when necessary,” Tsai said.

Senior author of the study was David Bangsberg, a Massachusetts General Hospital (MGH) physician specializing in HIV/AIDS research and director of the MGH Center for Global Health. The study was conducted in  collaboration with researchers at the University of California, San Francisco, and the University of California, Berkeley.

Support for the study included funding from the National Institute of Mental Health (NIMH). Tsai also received funding from the NIMH Institutional Training Award and the National Institutes of Health’s National Center for Research Resources UCSF-Clinical and Translational Science Institute grant.

–Marjorie Dwyer