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Study Shows Depression Worsens HIV Treatment
(06/21/2008) by Kaiser Permanente
Oakland, Calif. — The largest study to examine the effect of depression on HIV treatment found that depression significantly worsens a patient's adherence to highly active antiretroviral therapy and clinical measures, but that effective antidepressant medication can reverse this outcome, according to a study by the Kaiser Permanente Division of Research and the Group Health Cooperative published in the current online issue of the Journal of Acquired Immune Deficiency Syndromes.
The study looked at 3,359 HIV-infected patients from seven Kaiser Permanente regions nationwide and Group Health in 2000 to 2003 to measure the effects of depression – with and without selective serotonin reuptake inhibitors (SSRI) use – on adherence and changes in viral and immunologic control in patients starting a new Highly Active AntiRetroviral Therapy regimen.
The researchers studied the patients’ HAART adherence, viral loads, and changes in CD4 T-cell counts over a 12-month period. The study found that depressed patients – 42 percent of the patient group – had a lower adherence rate and worse viral therapy response compared to non-depressed patients. But depressed patients who were prescribed SSRI medication and adhered to it had the same outcomes as non-depressed patients.
"The take-home point of this study is that depression carries a worse prognosis for HAART in HIV patients. However, we also found that SSRIs can reverse this and improve outcomes for HIV-depressed patients," said Michael A. Horberg, MD, MAS, FACP, Director of HIV/AIDS for Kaiser Permanente and the lead author on the study. "HIV and depression often go hand in hand. If you are HIV-infected, you should be screened regularly for depression, and if you are depressed and you are going to go on HAART, it's very worthwhile to treat your depression."
Kaiser Permanente and Group Health are the second largest provider of HIV care in the United States, caring for more than 17,000 patients annually. Recent quality performance analysis show that Kaiser Permanente and Group Health HIV patients have a very high rate of adhering to their medicine, strong viral control and good responses to therapy.
Co-authors on the study included Kaiser Permanente’s Michael Silverberg, PhD, MPH, Leo Hurley, MPH, William Towner, MD, Daniel Klein, MD, Susan Bersoff-Matcha, MD, Winkler Weinberg, MD, Diana Antoniskis, MD, Miguel Mogyoros, MD, Robert Dobrinich, MD, Charles Quesenberry, PhD, and Drew Anthony Kovach, MD, and Wayne Dodge, MD, of Group Health.
Source:
www.ckp.kp.org
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