Greater chronicity of depression increased the likelihood of failure at multiple points along the HIV care continuum, according to a recent study. Even modest increases in the proportion of time spent with depression led to clinically meaningful increases in negative outcomes. The study comprised an observational clinical cohort of 5,927 patients with ≥2 assessments of depressive severity who were receiving HIV primary care at 6 geographically dispersed US academic medical centers. Researchers found:
- During 10,767 person-years of follow-up, the total participants (5,000 men, 926 women, and 1 intersex individual; median age, 44 years) had a median percentage of days with depression (PDD) of 14%.
- During follow-up, 10,361 of 55,040 scheduled visits (18.8%) were missed, 6,191 of 28,455 viral loads (21.8%) were detectable, and the mortality rate was 1.5 deaths per 100 person-years.
- Compared with patients who spent no follow-up time with depression (PDD, 0%), those who spent the entire follow-up time with depression (PDD, 100%) faced a 37% increased risk of missing appointments, a 23% increased risk of a detectable viral load, and a doubled mortality rate.
Pence BW, Mills JC, Bengtson AM, et al. Association of increased chronicity of depression with HIV appointment attendance, treatment failure, and mortality among HIV-infected adults in the United States. [Published online ahead of print February 21, 2018]. JAMA Psychiatry.