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Higher depression and anxiety rates with HIV across ART and viral load categories
  22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018
Mark Mascolini
A comparison of more than 3000 people with HIV and a similar group without HIV confirmed higher prevalence of depression and anxiety in the HIV group [1]. These findings in the UK held true regardless of whether people took antiretroviral therapy (ART) or had an undetectable viral load.
Collaborators at the University College London and other centers noted that high prevalence of mental health problems is well documented in people with HIV infection. But mental health comparisons between people with and without HIV often share the same limitation: the HIV-negative group does not represent people at risk for HIV infection. The UK investigators sought to overcome this limitation by comparing an HIV cohort to a matched "at-risk" HIV-negative group.
The HIV contingent consisted of 3258 adults in the ASTRA study of people diagnosed with HIV in 2011-2012 at 8 UK HIV clinics. The HIV-negative group comprised 2630 adults in the AURAH study seen at 20 UK genitourinary medicine clinics in 2013-2014. People in both cohorts completed a questionnaire on sociodemographic, health, and lifestyle factors, including HIV diagnosis date and ART use in the HIV group. Researchers documented latest viral load in ASTRA participants.
The investigators matched HIV-negative AURAH participants to HIV-positive ASTRA participants on gender/sexual orientation, age, ethnicity, and education level. The matched data set included 5730 observations, 2865 from each study group. Outcomes were (1) depressive symptoms (PHQ-9 score >/= 10), (2) anxiety symptoms (GAD-7 score >/= 10), and (3) depression overall (PHQ-9 score >/= 10 or treatment for depression). To compare these outcomes in people with versus without HIV, the researchers used logistic generalized estimating equations adjusted for the matching variables.
Age averaged 45 years in both ASTRA and AURAH, about 72.5% in both groups were white, about 73% men who have sex with men (MSM), about 11% heterosexual men, and about 17% women. The same proportion in each group, 43%, had a university degree.
The ASTRA HIV group had a higher prevalence of all three outcomes than the AURAH HIV-negative group: depressive symptoms (27.0% versus 10.5%), anxiety symptoms (21.6% versus 9.6%), and depression overall (34.6% versus 16.2%). Adjusted odds ratios (aOR) indicated independently higher odds of all three outcomes in the ASTRA HIV group:
-- Depressive symptoms: aOR 3.3, 95% confidence interval [CI] 2.6 to 4.2.
-- Anxiety symptoms: aOR 2.7, 95% CI 2.1 to 3.5
-- Depression overall: aOR 2.6, 95% CI 2.0 to 3.2
These independently higher odds for all three outcomes held true in three HIV subgroups compared with HIV-negative controls: on ART and viral load at or below 50 copies, on ART and viral load above 50 copies, and not on ART. For the ART-treated group with an undetectable viral load, adjusted odds ratios were 3.1 for depressive symptoms, 2.7 for anxiety symptoms, and 2.6 for depression overall. Odds ratios for all three outcomes rose steadily with longer time since HIV diagnosis, but odds of the three outcomes were independently higher with HIV even within 2 years of HIV diagnosis.
Three other factors independently predicted the three mental health outcomes: younger age, being MSM or a woman (versus a heterosexual man), and lower education level. But ethnicity was not associated with worse mental health outcomes.
The researchers believe their findings "give further evidence that living with HIV has a considerable adverse impact on mental health."
1. Lampe F, Miners A, Kreif N, et al. Comparison of depression and anxiety between HIV-positive and HIV-negative people. AIDS 2018: 22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018. Abstract TUPEB079.