Chronic Depression Hastens Disease Progression and Mortality Among Women with HIV

Women who are HIV-positive and depressed are twice as likely to die as women who are HIV-positive but experiencing limited or no depressive symptoms, a study by a Yale researcher shows.
Women who are HIV-positive and depressed are twice as likely to die as women who are HIV-positive but experiencing limited or no depressive symptoms, a study by a Yale researcher shows.

The findings were published in the March 21 issue of the Journal of the American Medical Association. Despite depression being more prevalent among women than men, the study is believed to be the first to report an association between depression and morbidity and mortality for women with HIV.

The principal investigator, Jeannette Ickovics, associate professor of Epidemiology and Public Health at Yale School of Medicine, said the study highlights the importance of adequate diagnosis and treatment of depression among women with HIV.

The study also showed women with more advanced HIV disease were particularly vulnerable to the effects of depression. Among women with CD4 cell counts of less than 200, HIV-related mortality rates were 54 percent for those with chronic depressive symptoms; 48 percent for those with intermittent depressive symptoms, and 21 percent for those with limited or no depressive symptoms. The study took into account characteristics such as immune function, HIV-viral load and antiretroviral medication use.

“If we identify and treat depression among women with HIV, we have the opportunity to enhance their emotional well being as well as extend their years of life,” Ickovics said.

The data were drawn from the HIV Epidemiological Research Study (HERS), a large prospective study of the biological and psychosocial manifestations of HIV in women followed up for seven years. The study included 765 HIV positive women, 19-to-55, enrolled from April 1993 through January 1995 with follow up every six months through March 2000. Women were recruited from four study sites: Johns Hopkins School of Hygiene and Public Health, Baltimore, Md.; Montefiore Medical Center, Bronx, N.Y.; Miriam Hospital, Brown University, Providence, R.I., and Wayne State Hospital University School of Medicine, Detroit, Mich.

Women with an AIDS diagnosis or any AIDS-defining opportunistic infections were considered late in disease progression and were ineligible for the study.

The study was undertaken, Ickovics said, because although clinical levels of depression have been reported by 30 percent to 60 percent of women with HIV in community and clinic samples, there was no study conducted of depression’s effect on the women’s disease progression and survival rate.

“The mechanism for this effect is not fully understood,” she said. “Depression may impact mortality for women with HIV directly via effects on immune suppression. Alternatively, depression may impact mortality indirectly via effects on health care utilization or adherence to treatment recommendations.”

“Further research is required to understand exactly how depression affects disease progression for women and men with HIV, as well as those suffering from other chronic illnesses,” she added. “This is critical because millions of Americans suffer from depression.”

The other researchers on the study were Merle Hamburger from the Centers for Disease Control and Prevention; David Vlahov, the New York Academy of Medicine; Elie Schoenbaum, M.D., Montefiore Medical Center; Paula Schumann, M.D., Wayne State University and Hospital; Robert Boland, M.D., Brown University; and Janet Moore, the CDC.

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