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Antidepressant Treatment and Adherence to Combination Antiretroviral Therapy among Patients with AIDS and Diagnosed Depression

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Abstract

Background

The prevalence of depression is elevated among HIV-infected individuals and there is evidence that depression exerts a negative impact on HIV medication adherence.

Methods

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.

Results

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]).

Conclusions

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.

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Acknowledgements

Support for this research was provided by funding from grants: MH 58984-03, MH 60831, MH076206-01 and HS 016097.

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Authors and Affiliations

  1. Institute for Health, Health Care, Policy and Aging Research, 30 College Avenue, New Brunswick, NJ, 08901, USA

    James Walkup, Wenhui Wei & Stephen Crystal

  2. Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA

    Usha Sambamoorthi

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  1. James Walkup
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  2. Wenhui Wei
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  3. Usha Sambamoorthi
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  4. Stephen Crystal
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Correspondence to James Walkup.

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Walkup, J., Wei, W., Sambamoorthi, U. et al. Antidepressant Treatment and Adherence to Combination Antiretroviral Therapy among Patients with AIDS and Diagnosed Depression. Psychiatr Q 79, 43–53 (2008). https://doi.org/10.1007/s11126-007-9055-x

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