Depressive Symptoms May Increase the Risk of Death in Patients With HIV

HIV-positive veterans with depressive symptoms may have a higher risk of death than those who are HIV negative, according to a study in HIV Medicine.

The study was conducted to examine the relationship between depressive disorders and symptoms, HIV status, and mortality.

"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," corresponding author Kaku So-Armah, PhD, assistant professor of medicine at Boston University School of Medicine, said in a statement.

Researchers used data from respondents of the Veteran’s Aging Cohort Study to first compare the risk of death among United States veterans who had depressive symptoms with those who didn’t have depression. They then compared the association between depression and death among those who were infected with HIV to those who were HIV negative. Depression and depressive symptoms were determined by International Classification of Diseases, Ninth Revision (ICD-9) clinical diagnostic codes and Patient Health Questionnaire-9 (PHQ) scores greater than or equal to 10.

Among HIV positive veterans, researchers found a 23% increased risk of death associated with depressive symptoms determined by PHQ-9 results. However, no significantly increased risk of death was found when depression was ascertained by the ICD-9 codes. For HIV-negative veterans, there was a 6% increased risk of death associated with depression measured by ICD-9 codes but no significantly increased risk of death was found for depressive symptoms assessed by PHQ-9.

Data from 129,140 veterans were evaluated between April 1, 2003, to September 30, 2015. Out of all respondents, 30% were infected with HIV, 16% were diagnosed with depression, and 24% died within a median follow-up period of 11 years. The mortality rate was 25.3 deaths per 1000 person-years. Depression was associated with mortality, but the association was modified by HIV status. However, in HIV-stratified analyses, depression was significantly associated with mortality among veterans who were HIV negative but not among those who were HIV positive.

Among veterans who answered the questionnaire, 50% were infected with HIV, 22% had PHQ-9 scores greater than or equal to 10, and 28% died within a median follow-up period of 12 years. The mortality rate was 27.3 deaths per 1000 person-years. Depressive symptoms were associated with mortality but the association was also modified by HIV status. In HIV-stratified analyses, depressive symptoms were significantly associated with mortality among veterans who were HIV positive but not among those who were HIV negative.

The researchers believe that screening and treatment for depression is critical for individuals living with HIV as significant advancements have been made in antiretroviral therapy and life expectancy. They acknowledge that while clinical guidelines recommend routine screening for depression, adherence to guidelines is only marginally successful. As a result, many cases of depression among individuals with HIV are left undiagnosed and depressive symptoms are left untreated.

"This needs to be improved,” researchers wrote. “Better understanding of barriers to and facilitators of effective depression screening and integration of depression treatment into HIV primary care is needed."

Depression is the most frequently reported mental health condition affecting individuals with HIV in the United States. Prevalence rates among these individuals range between 20% to 40%.

Reference

So-Armah K, Gupta SK, Kundu S, et al. Depression and all-cause mortality risk in HIV-infected and HIV-uninfected US veterans: a cohort study [published online March 29, 2019]. HIV Med. doi: 10.1111/hiv.12726.