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

HIV Research, Kaiser Permanente, Oakland, CA 94612, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.39). 03/2008; 47(3):384-90. DOI: 10.1097/QAI.0b013e318160d53e
Source: PubMed

ABSTRACT 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.
Retrospective cohort study.
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.
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 > or =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.
Depression significantly worsens HAART adherence and HIV viral control. Compliant SSRI use is associated with improved HIV adherence and laboratory parameters.

Download full-text


Available from: William Towner, Jul 04, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The importance of antiretroviral therapy adherence for patients living with HIV/AIDS has been well documented. Despite this critical need, many do not follow prescribed regimens. To examine the barriers that lead to non-adherence, we used cross-sectional survey data from a randomized controlled intervention trial in northern and north-eastern Thailand. Of the 507 patients that were enrolled in the trial, we analyzed 386 patients on antiretroviral therapy in order to examine the barriers to adherence. In addition to demographic characteristics, depressive symptoms, physical health, access to care, social support, and internalized shame, HIV disclosure and family communication were examined. The correlation analysis revealed that adherence is significantly associated with internalized shame, access to care, depressive symptoms, and family communication. Based on the multiple logistic regression analysis, depressive symptoms, access to care, HIV disclosure, and family communication were significant predictors of adherence. Having depressive symptoms remains a significant barrier to adherence, while access to care, HIV disclosure, and family communication play important positive roles. Our findings underscore the critical importance of addressing these various challenges that can influence adherence to antiretroviral therapy.
    Nursing and Health Sciences 03/2010; 12(2):212 - 220. DOI:10.1111/j.1442-2018.2010.00521.x · 0.85 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Stress qualitatively and quantitatively impairs immune function via the activation of main two neuroendocrine pathways, the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic branch of the autonomic nervous system (ANS). Stress-induced immune impairments appear to be large enough to alter the course of viral diseases, including enhancing the risk for more severe viral infections, delaying the healing time, reducing the immune response to antiviral vaccines, and reactivating latent herpesviruses (e.g. herpes simplex virus) and latent tumor promoting viruses (e.g. Epstein-Barr virus). Nowadays, physicians emphasize the importance of accurately identifying and effectively managing with psychopharmacological interventions stressful life experiences, since psychoactive drugs such as serotonergic antidepressant reduce the suppressive effects of stress on immune function and improve the progression of medical diseases.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We report on recent progress with the gauge-fixing approach to lattice chiral gauge theories. The bosonic sector of the gauge-fixing approach is studied with fully dynamical U(1) gauge fields. We demonstrate that it is important to formulate the Lorentz gauge-fixing action such that the dense set of lattice Gribov copies is removed, and the gauge-fixing action has a unique absolute minimum. We then show that the spectrum in the continuum limit contains only the desired massless photon, as expected.
    Nuclear Physics B - Proceedings Supplements 10/1999; DOI:10.1016/S0920-5632(00)91750-X · 0.88 Impact Factor