The effect of antidepressant treatment on HIV and depression outcomes. (24th September 2015)

• Record Type: Journal Article
• Authors: Pence, Brian W.; Gaynes, Bradley N.; Adams, Julie L.; Thielman, Nathan M.; Heine, Amy D.; Mugavero, Michael J.; McGuinness, Teena; Raper, James L.; Willig, James H.; Shirey, Kristen G.; Ogle, Michelle; Turner, Elizabeth L.; Quinlivan, E. Byrd
• Is Part Of: AIDS. Volume 29:Number 15(2015)
• Publication Date: 2015-09-24
• Subjects: AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000000797
• Languages: English
• ISSNs: 0269-9370

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p>Depression is a major barrier to HIV treatment outcomes.</p> </sec> <sec> <title>Objective:</title> <p>To test whether antidepressant management decision support integrated into HIV care improves antiretroviral adherence and depression morbidity.</p> </sec> <sec> <title>Design:</title> <p>Pseudo-cluster randomized trial.</p> </sec> <sec> <title>Setting:</title> <p>Four US infectious diseases clinics.</p> </sec> <sec> <title>Participants:</title> <p>HIV-infected adults with major depressive disorder.</p> </sec> <sec> <title>Intervention:</title> <p>Measurement-based care (MBC) – depression care managers used systematic metrics to give HIV primary-care clinicians standardized antidepressant treatment recommendations.</p> </sec> <sec> <title>Measurements:</title> <p>Primary – antiretroviral medication adherence (monthly unannounced telephone-based pill counts for 12 months). Primary time-point – 6 months. Secondary – depressive severity, depression remission, depression-free days, measured quarterly for 12 months.</p> </sec> <sec> <title>Results:</title> <p>From 2010 to 2013, 149 participants were randomized to intervention and 155 to usual care. Participants were mostly men, Black, non-Hispanic, unemployed, and virally suppressed with high baseline self-reported antiretroviral adherence and depressive severity. Over follow-up, no differences between arms in antiretroviral adherence or other HIV outcomes were apparent. At 6 months, depressive severity was lower among intervention participants than usual care [mean difference −3.7, 95% confidence interval (CI) −5.6, −1.7], probability of depression remission was higher [risk difference 13%, 95% CI 1%, 25%), and suicidal ideation was lower (risk difference −18%, 95% CI −30%, −6%). By 12 months, the arms had comparable mental health outcomes. Intervention arm participants experienced an average of 29 (95% CI: 1–57) more depression-free days over 12 months.</p> </sec> <sec> <title>Conclusion:</title> <p>In the largest trial of its kind among HIV-infected adults, MBC did not improve HIV outcomes, possibly because of high baseline adherence, but achieved clinically significant depression improvements and increased depression-free days. MBC may be an effective, resource-efficient approach to reducing depression morbidity among HIV patients.</p> </sec> </abstract>