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Clin Infect Dis. 2019 Jan 18;68(3):475-481. doi: 10.1093/cid/ciy496.

Depressive Symptoms and Engagement in Human Immunodeficiency Virus Care Following Antiretroviral Therapy Initiation.

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Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.
Department of Epidemiology, University of North Carolina at Chapel Hill.
Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health.
Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island.
Fenway Institute, Fenway Health, Boston, Massachusetts.
Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Baltimore, Maryland.
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
HIV/AIDS Division, San Francisco General Hospital, University of California.
Department of Psychiatry, Massachusetts General Hospital, Boston.
Department of Psychiatry, University of California, San Diego.
Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill.
Department of Medicine, School of Medicine, University of Washington, Seattle.
Department of Medicine and UAB Center for AIDS Research, University of Alabama at Birmingham.



The effect of depressive symptoms on progression through the human immunodeficiency virus (HIV) treatment cascade is poorly characterized.


We included participants from the Centers for AIDS Research Network of Integrated Clinic Systems cohort who were antiretroviral therapy (ART) naive, had at least 1 viral load and HIV appointment measure after ART initiation, and a depressive symptom measure within 6 months of ART initiation. Recent depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) and categorized using a validated cut point (PHQ-9 ≥10). We followed participants from ART initiation through the first of the following events: loss to follow-up (>12 months with no HIV appointment), death, administrative censoring (2011-2014), or 5 years of follow-up. We used log binomial models with generalized estimating equations to estimate associations between recent depressive symptoms and having a detectable viral load (≥75 copies/mL) or missing an HIV visit over time.


We included 1057 HIV-infected adults who contributed 2424 person-years. At ART initiation, 30% of participants reported depressive symptoms. In multivariable analysis, recent depressive symptoms increased the risk of having a detectable viral load (risk ratio [RR], 1.28; 95% confidence interval [CI], 1.07, 1.53) over time. The association between depressive symptoms and missing an HIV visit (RR, 1.20; 95% CI, 1.05, 1.36) moved to the null after adjustment for preexisting mental health conditions (RR, 1.00; 95% CI, 0.85, 1.18).


Recent depressive symptoms are a risk factor for unsuppressed viral load, while preexisting mental health conditions may influence HIV appointment adherence.

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