Depression severity is associated with increased risk behaviors and decreased CD4 cell counts

Abstract

Depression is a common comorbidity among HIV-infected individuals. We studied the relationship between depressive symptoms, risk behaviors (risky-sexual behavior, tobacco, alcohol, and illicit drug use) and HIV outcomes. This cross-sectional study conducted in 2009 at the Washington University HIV Clinic included screening for depression with patient health questionnaire, survey of sexual behavior, illicit drug, alcohol, and tobacco use within 30 days. Sociodemographics, plasma HIV RNA levels, CD4 cell counts, and sexually transmitted disease test results were obtained from medical records. Multivariate logistic and linear regression models were used to assess the association between depressive symptoms severity and risk behaviors, HIV outcomes and combination antiretroviral therapy (cART) adherence. A total of 624 persons completed the assessment of whom 432 (69%) were male and 426 (68%) African-American. The median CD4 cell count was 410 cells/mm³ and 479 persons (77%) were on cART of whom 112 (23%) had HIV RNA level > 400 copies/mL. Overall, 96 (15%) had symptoms of major depressive disorder. Depressive symptom severity was associated with increased likelihood of high-risk drinking (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1–5.1), current tobacco use (OR, 1.8; 95% CI, 1.1–2.9), illicit drug use (OR, 1.7; 95% CI, 1.0–2.8), and risky-sexual behavior (OR, 1.5; 95% CI, 0.8–2.7). Suboptimal cART adherence (visual analog scale < 95%) was also associated with depressive symptoms severity (p < 0.05). After adjustment for age, sex, race, receipt of cART, and cART adherence, depressive symptoms severity was independently associated with lower CD4 cell count (p < 0.05) but not with higher HIV RNA level (p = 0.39). Depression adversely affects HIV-infected individuals, requiring greater effort at utilizing multidisciplinary interventions.

Keywords:

• HIV
• depression
• risk behaviors
• antiretroviral therapy
• adherence

Acknowledgment

We would like to thank the patients and the staff at the Washington University HIV Clinic. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH

Funding

TT was supported by the Bristol-Myers Squibb Virology Fellowship Program. ES was supported by NIH-National Center for Research Resources (NCRR) [grant number UL1 RR024992], specifically [KL2 RR024994].

Supplementary material

Supplementary (Figures S1 and S2; Table S1) is available via the ‘Supplementary’ tab on the article's online page (http://dx.doi.org/10.1080/09540121.2014.880399).