HIV Patients Risk Higher Mortality Associated with Depressive Symptoms

Patients with human immunodeficiency virus (HIV) incur a higher chance of dying from depressive symptoms compared to patients without HIV, according to a study published  by researchers from Boston University School of Medicine (BUSM) in HIV Medicine.

Depression affects approximately 20 to 40 percent of HIV patients living in the US, making it the most frequently reported mental health condition in people living with the virus. Depressive disorders have previously been linked to augmented mortality in people with chronic diseases, including heart disease, end-stage renal disease and diabetes.

In this study, researchers analyzed data from 129,140 eligible participants of the Veteran’s Aging Cohort Study (VACS) from April 2003 through September 2015. Among all participants, 30% had HIV, 16% had a major depressive disorder diagnosis, and 24% died over a median follow-up of 11 years. Depression definitions were major depressive disorder defined using International Classification of Diseases, Ninth Revision (ICD-9) codes, and depressive symptoms were defined as Patient Health Questionnaire (PHQ)-9 scores ≥ 10. The study outcome was all-cause mortality, and covariates were demographics, comorbid conditions and health behaviors.

Depression Kills HIV Patients

The results indicate that major depressive disorder was associated with mortality (HR=1.04; 95% CI, 1.01 to 1.07). The correlation was modified by HIV status (interaction P‐value=0.02). In HIV‐stratified analyses, depression was significantly tied to mortality among HIV‐uninfected veterans but not among those with HIV infection. Moreover, among those with PHQ‐9 data (n=7372), 50% had HIV infection, 22% had PHQ‐9 scores ≥ 10, and 28% died over a median follow‐up time of 12 years. The death rate was 27.3 (95% CI, 26.1 to 28.5) per 1,000 person‐years.

Furthermore, depressive symptoms were associated with mortality (HR=1.16; 95% CI, 1.04 to 1.28). This correlation was modified by HIV status (interaction P‐value=0.05). Overall, in HIV‐stratified analyses, depressive symptoms were significantly associated with mortality among veterans with HIV infection but not among those without HIV infection.

Important to Assess and Treat Depression

Researchers noted the importance of identifying and treating depression, particularly among those living with HIV since significant strides have been made in enhancing HIV life expectancy. “Our findings reinforce the need to assess and treat depressive symptoms and major depressive disorder in patients with and without HIV infection to potentially reduce mortality risk,” said Kaku So-Armah, PhD, assistant professor of medicine at BUSM and corresponding author of the study, in a press release.

According to the research team, despite clinical guidelines recommending routine screening for depressive symptoms, there is only moderate success in diagnosing depression among people with HIV infection.

“This needs to be improved; better understanding of barriers to and facilitators of effective depression screening and integration of depression treatment into HIV primary care is needed.”