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AIDS Behav. 2017 Nov;21(11):3238-3246. doi: 10.1007/s10461-017-1788-4.

Depression and Anxiety are Common in Acute HIV Infection and Associate with Plasma Immune Activation.

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Department of Neurology, University of California, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.
SEARCH, The Thai Red Cross AIDS Research Center, Bangkok, Thailand.
Department of Neurology, University of California, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.
Department of Neurology, Yale University, New Haven, CT, USA.
U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
Department of Tropical Medicine, Medical Microbiology and Pharmacology, University of Hawaii, Honolulu, HI, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA.


This observational study of 123 Thai participants sought to determine the rate and severity of affective symptoms during acute HIV infection (AHI) and possible associations to disease mechanisms. At diagnosis, just prior to starting combination antiretroviral therapy (cART), AHI participants completed assessments of depression and anxiety symptoms that were repeated at 4, 12, and 24 weeks. Blood markers of HIV infection and immune activation were measured at study entry, with optional cerebrospinal fluid measures. A high frequency of participants reported symptoms that exceeded published thresholds supportive of depression (55.0%) and anxiety (65.8%) at diagnosis, with significant reductions after starting cART. Meeting a threshold for clinically relevant depressive symptoms at study entry was associated with higher baseline plasma HIV RNA (5.98 vs. 5.50, t = 2.46, p = 0.015), lower CD4 counts (328 vs. 436 cells/mm3, t = 3.46, p = 0.001), and higher plasma neopterin, a marker of macrophage activation (2694 vs. 1730 pg/mL, Mann-Whitney U = 152.5, p = 0.011). Controlling for plasma HIV RNA and CD4 count, higher baseline plasma neopterin correlated with worse initial depression and anxiety scores. Depression and anxiety symptoms are frequent in acute HIV infection, associate with plasma immune activation, and can improve concurrent with cART.


Acute infection; Anxiety; Depression; Men who have sex with men; Neopterin

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