AIDS and Behavior

, Volume 22, Issue 5, pp 1542–1550 | Cite as

Association Between Depression and Antiretroviral Therapy Use Among People Living with HIV: A Meta-analysis

  • Jun Tao
  • Sten H. Vermund
  • Han-Zhu Qian
Substantive Review


Depression is common among people living with HIV (PLHIV). Studies on the relationship between depression and use of antiretroviral therapy (ART) are inconclusive. A meta-analysis was conducted to summarize the relationship between depression and ART use among PLHIV. Ten electronic databases, conference abstracts, and dissertations were searched. A random effects meta-analysis was performed to pool the odds ratio estimates from eligible studies. Subgroup analyses and meta-regression were conducted for moderator analysis. Sensitivity analysis was performed to find influential studies. A funnel plot, the Egger test, and the trim and fill analysis were used to detect publication bias. The pooled sample size was 7375 PLHIV from nine eligible studies. The pooled prevalence of depression was 41% (95% confidence interval [CI] 29–53%). The pooled ART use rate was 52% (95% CI 37–67%). PLHIV with depression were 14% less likely (pooled odds ratio [OR] = 0.86; 95% CI 0.71–1.05) to use ART than those without depression. Subgroup analyses showed that depression was significantly associated with no ART use (pooled OR 0.84; 95% CI 0.71–0.99) among studies with a prospective study design (11 estimates from nine studies). Moderator analyses did not show any statistically significant effects. The publication bias analyses showed small study effects may not exist. Depression was associated with non-use of ART among PLHIV. Studies are needed to explore this association in other countries with varied populations, as most published studies have been conducted in the United States.


Depression Antiretroviral therapy People living with HIV (PLHIV) Meta-analysis Systematic review 



We appreciate that Aaron M. Kipp, Bryan E. Shepherd, Emily E. Tanner-Smith, and K. Rivet Amico provide their valuable comments on this work.


This study was funded by the United States National Institutes of Health under Award Numbers R01AI094562 and R34AI091446.

Author contributions

HQ, JT, and SV initiated this study. JT searched for related literature, information extraction, and analysis. HQ and SV provided valuable suggestions and comments for this manuscript.

Compliance with Ethical Standards

Conflict of interest

Sten Vermund received Grant R01AI094562 and R34AI091446 from the United States National Institutes of Health. He has no conflict of interest. Jun Tao and Han-Zhu Qian declare no conflict of interest.

Ethical Approval

This study was non-human subject study focusing on review of published literature. It did not involve animals.

Informed Consent

Our study did not involve human beings.


  1. 1.
    Uthman OA, Magidson JF, Safren SA, Nachega JB. Depression and adherence to antiretroviral therapy in low-, middle- and high-income countries: a systematic review and meta-analysis. Curr HIV/AIDS Rep. 2014;11(3):291–307.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Chisholm D, Sweeny K, Sheehan P, et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry. 2016;3(5):415–24.CrossRefPubMedGoogle Scholar
  3. 3.
    Mayston R, Patel V, Abas M, et al. Psychological predictors for attendance of post-HIV test counselling and linkage to care: the Umeed cohort study in Goa, India. BMC Psychiatry. 2014;14:188.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Traeger L, O’Cleirigh C, Skeer MR, Mayer KH, Safren SA. Risk factors for missed HIV primary care visits among men who have sex with men. J Behav Med. 2012;35(5):548–56.CrossRefPubMedGoogle Scholar
  5. 5.
    Ramirez-Avila L, Regan S, Giddy J, et al. Depressive symptoms and their impact on health-seeking behaviors in newly-diagnosed HIV-infected patients in Durban, South Africa. AIDS Behav. 2012;16(8):2226–35.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bhatia R, Hartman C, Kallen MA, Graham J, Giordano TP. Persons newly diagnosed with HIV infection are at high risk for depression and poor linkage to care: results from the Steps Study. AIDS Behav. 2011;15(6):1161–70.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Skodol AE, Schwartz S, Dohrenwend BP, Levav I, Shrout PE. Minor depression in a cohort of young adults in Israel. Arch Gen Psychiatry. 1994;51(7):542–51.CrossRefPubMedGoogle Scholar
  8. 8.
    Croda J, Croda MG, Neves A, dos Santos SDS. Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit. Crit Care Med. 2009;37(5):1605.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Powderly WG, Landay A, Lederman MM. Recovery of the immune system with antiretroviral therapy: the end of opportunism? JAMA. 1998;280(1):72–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Rodger AJ, Sabin CA. How have guidelines on when to start antiretroviral therapy affected survival of people living with HIV infection? Curr Opin HIV AIDS. 2016;11(5):487–91.CrossRefPubMedGoogle Scholar
  11. 11.
    Vermund SH, Hayes RJ. Combination prevention: new hope for stopping the epidemic. Curr HIV/AIDS Rep. 2013;10(2):169–86.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Mountain E, Mishra S, Vickerman P, Pickles M, Gilks C, Boily MC. Antiretroviral therapy uptake, attrition, adherence and outcomes among HIV-infected female sex workers: a systematic review and meta-analysis. PLoS ONE. 2014;9(9):e105645.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Mugglin C, Estill J, Wandeler G, et al. Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis. Trop Med Int Health. 2012;17(12):1509–20.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Wolfe D, Carrieri MP, Shepard D. Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. The Lancet. 2010;376(9738):355–66.CrossRefGoogle Scholar
  15. 15.
    Martinez P, Andia I, Emenyonu N, et al. Alcohol use, depressive symptoms and the receipt of antiretroviral therapy in Southwest Uganda. AIDS Behav. 2008;12(4):605–12.CrossRefPubMedGoogle Scholar
  16. 16.
    Tegger MK, Crane HM, Tapia KA, Uldall KK, Holte SE, Kitahata MM. The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals. AIDS Patient Care STDs. 2008;22(3):233–43.CrossRefPubMedGoogle Scholar
  17. 17.
    Goodness TM, Palfai TP, Cheng DM, et al. Depressive symptoms and antiretroviral therapy (ART) initiation among HIV-infected Russian drinkers. AIDS Behav. 2014;18(6):1085–93.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Cook JA, Grey DD, Burke-Miller JK, et al. Illicit drug use, depression and their association with highly active antiretroviral therapy in HIV-positive women. Drug Alcohol Depend. 2007;89(1):74–81.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Cohen MH, Cook JA, Grey D, et al. Medically eligible women who do not use HAART: the importance of abuse, drug use, and race. Am J Public Health. 2004;94(7):1147–51.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hightow-Weidman LB, Jones K, Phillips G II, Wohl A, Giordano TP. Baseline clinical characteristics, antiretroviral therapy use, and viral load suppression among HIV-positive young men of color who have sex with men. AIDS Patient Care STDs. 2011;25(Sup1):S9–14.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lillie-Blanton M, Stone VE, Jones AS, et al. Association of race, substance abuse, and health insurance coverage with use of highly active antiretroviral therapy among HIV-infected women, 2005. Am J Public Health. 2010;100(8):1493–9.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Baez Feliciano DV, Gomez MA, Fernandez-Santos DM, Quintana R, Rios-Olivares E, Hunter-Mellado RF. Profile of puerto rican HIV/AIDS patients with early and non-early initiation of injection drug use. Ethn Dis. 2008;18(2 Suppl 2):S2-99–-104.Google Scholar
  23. 23.
    Himelhoch S, Moore RD, Treisman G, Gebo KA. Does the presence of a current psychiatric disorder in AIDS patients affect the initiation of antiretroviral treatment and duration of therapy? JAIDS. 2004;37(4):1457–63.PubMedGoogle Scholar
  24. 24.
    Mijch A, Burgess P, Judd F, et al. Increased health care utilization and increased antiretroviral use in HIV-infected individuals with mental health disorders. HIV Med. 2006;7(4):205–12.CrossRefPubMedGoogle Scholar
  25. 25.
    Turner BJ, Fleishman JA. Effect of dysthymia on receipt of HAART by minority HIV-infected women. J Gen Intern Med. 2006;21(12):1235–41.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Egger M, Smith GD, Altman DG. Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ; 2001.CrossRefGoogle Scholar
  28. 28.
    Gardner LI, Holmberg SD, Moore J, et al. Use of highly active antiretroviral therapy in HIV-infected women: impact of HIV specialist care. JAIDS. 2002;29(1):69–75.PubMedGoogle Scholar
  29. 29.
    Amiya RM, Poudel KC, Poudel-Tandukar K, Kobayashi J, Jimba M. Antiretroviral therapy as a risk factor for depression, suicidal ideation, and suicide attempts among people living with HIV/AIDS in the Kathmandu Valley, Nepal. Sex Transm Infect. 2013;89:333–4.CrossRefGoogle Scholar
  30. 30.
    Cook JA, Cohen MH, Burke J, et al. Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV-seropositive women. JAIDS. 2002;30(4):401–9.PubMedGoogle Scholar
  31. 31.
    Turner BJ, Fleishman JA, Wenger N, et al. Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons. J Gen Intern Med. 2001;16(9):625–33.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Tao J, Vermund SH, Lu H, et al. Impact of depression and anxiety on initiation of antiretroviral therapy among men who have sex with men with newly diagnosed HIV infections in China. AIDS Patient Care STDs. 2017;31(2):96–104.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Roca M, Lopez-Navarro E, Monzon S, et al. Cognitive impairment in remitted and non-remitted depressive patients: a follow-up comparison between first and recurrent episodes. Eur Neuropsychopharmacol. 2015;25(11):1991–8.CrossRefPubMedGoogle Scholar
  34. 34.
    UNAIDS. UNAIDS report on the global AIDS epidemic. In: UNAIDS, WHO; 2013.Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Vanderbilt Institute for Global HealthVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of PediatricsVanderbilt University Medical CenterNashvilleUSA
  3. 3.Department of MedicineVanderbilt University Medical CenterNashvilleUSA
  4. 4.NashvilleUSA

Personalised recommendations