Antidepressant Treatment and Adherence to Combination Antiretroviral Therapy among Patients with AIDS and Diagnosed Depression
- 172 Downloads
The prevalence of depression is elevated among HIV-infected individuals and there is evidence that depression exerts a negative impact on HIV medication adherence.
Merged HIV/AIDS surveillance data and Medicaid claims data from January 1996 to December 1998 were used to identify AIDS-infected patients with diagnosed depression, and filled prescriptions were used to identify their antidepressant use, and highly active antiretroviral therapy (HAART). Chi-square tests and robust logistic regressions were used to examine antidepressant use after HAART initiation, and a person-month approach was used to estimate the association between antidepressant treatment and adherence to HAART after its initiation.
Of the 406 AIDS-infected patients diagnosed with depression who initiated HAART during this period, 81% (N = 329) were treated with an antidepressant. The HAART adherence rate was low overall. After HAART initiation; only 63% of the person-months had a prescription for it. However, use of an antidepressant in the prior month was significantly associated with HAART in the current month. After controlling for other factors, the odds of current-month HAART adherence were increased by almost 30% for those with antidepressant use in the prior month (Adjusted OR = 1.28, 95% CI [1.16, 1.41]).
While the HAART adherence rate was low among patients with AIDS diagnosed with depression, prior month’s antidepressant use increases odds of adherence. Unmeasured factors may influence the reported association between antidepressant use and HAART adherence, but our findings point to the need to investigate directly the impact of antidepressant therapy on HAART adherence found among patients with AIDS and depression.
KeywordsHIV Adherence Depression Antidepressant
Support for this research was provided by funding from grants: MH 58984-03, MH 60831, MH076206-01 and HS 016097.
- 3.Stober D, Schwartz J, McDaniel J, Abrams R: Depression and HIV disease: Prevalence, correlates, and treatment. Psychiatric Annals 27:372–377, 1997Google Scholar
- 10.Starace F, Ammassari A, Trotta MP, DeLongis P, Izzo C, Scalzini A, et al.: Depression is a risk factor for suboptimal adherence to highly active antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes 31 (suppl 3):136–139, 2002Google Scholar
- 11.Carrieri MP, Leport C, Protopopescu C, Cassuto J, Bouvet E, Peyramond D, Raffi F, Moatti J, Chene G, Spire B: Factors associated with nonadherence to highly active antiretroviral therapy: A 5-year follow-up analysis with correction for the bias induced by missing data in the treatment maintenance phase. Journal of Acquired Immune Deficiency Syndromes 41:477–485, 2006PubMedCrossRefGoogle Scholar
- 13.Li X, Margolick J, Conover C, Badri S, Riddler S, Witt M, Jacobson L: Interruption and discontinuation of highly active antiretroviral therapy in the multicenter AIDS cohort study. Journal of Acquired Immune Deficiency Syndromes 38:314–319, 2005Google Scholar
- 25.Brechtl JR, Breitbart W, Galietta M, Krivo S, Rosenfeld B: The use of highly active antiretroviral therapy (HAART) in patients with advanced HIV infection: impact on medical, palliative care, and quality of life outcomes. Journal of Pain and Symptom Management 21:41–51, 2001PubMedCrossRefGoogle Scholar
- 27.Low-Beer S, Chan K, Yip B, et al.: Depressive symptoms among persons on HIV protease inhibitors. Journal of Acquired Immunodeficiency Syndrome 23:295–301, 2000Google Scholar
- 29.New Jersey DHSS: New Jersey HIV/AIDS Cases Reported as of December 31, 1996: Divison of AIDS Prevention and Control, New Jersey Department of Health and Senior Servies, Trenton, 1997Google Scholar
- 34.Bogart LM, Kelly JA, Catz SL, Sosman JM: Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment. Journal of Acquired Immune Deficiency Syndrome 23:396–404, 2000Google Scholar
- 35.StataCorp. Stata Statistical Software (Version 8.2). College Station, TX: Stata Corporation, 2004Google Scholar