AEGiS-08IAC: Depression predicts accelerated CD4 decline among gay men in San Francisco.

8th International AIDS Conference

Amsterdam, Netherlands — July 19-24, 1992

Depression predicts accelerated CD4 decline among gay men in San Francisco.

Int Conf AIDS 1992 Jul 19-24; 8:We50 (abstract no. WeC 1031)
Burack JH, Stall RD, Barrett DC, Coates TJ; San Francisco General Hospital, CA.

OBJECTIVES: To determine whether, in a cohort of HIV-infected gay and bisexual men, a high level of depressive symptomatology predicts more rapid decline of CD4 counts, progression to AIDS, and death.

METHODS: Analysis of data from the San Francisco Men's Health Study, a prospective population-based cohort study with semiannual follow-up. Eligible subjects: all HIV-seropositive gay or bisexual SFMHS participants who did not have AIDS as of January 1985 (N = 308). Chief predictor variable: score on the CES-D, a 20-item self-report inventory on which scores of greater than or equal to 16 correlate with clinical diagnoses of depression. Other predictors: baseline CD4 count, hematocrit, serum beta-2-microglobulin, and p24 antigenemia; and whether zidovudine was taken during the study period. Best-fit linear regression lines were calculated for CD4 over the period January 1985-January 1989 for all subjects who had greater than or equal to 3 CD4 counts. Outcomes variables: slope of the CD4 regression line, mortality, and progression to AIDS. Associations were tested with standard t tests.

RESULTS: 291 subjects had complete baseline data. Median CD4 count was 535 per microliter. CES-D score was greater than or equal to 16 in 20%, comparable to the rate in the general population. There were no differences between those with CES-D greater than or equal to 16 compared to those scoring less than 16 in baseline CD4 count, hematocrit, beta-2-microglobulin, or p24 antigenemia, nor in the proportion using zidovudine. Regression lines were calculated for 256 subjects; depressed subjects were more likely to be excluded from this analysis because of having too few CD4 counts (21% vs. 10%, p less than 0.05). Subjects with CES-D greater than or equal to 16 had a mean rate of CD4 decline of 10.2 cells/microliters/month, compared to a mean of 6.8 cells/microliters/month for those with CES-D less than 16 (p = 0.058, 2-tailed). Over 4 years, 28% of subjects progressed to AIDS; there was no difference between the high- and low-CES-D groups. But there was a trend toward higher 4-year mortality in the more depressed group: 28% vs. 19% (p = 0.12).

CONCLUSIONS: Among gay and bisexual men with early HIV disease, CES-D scores corresponding to clinical depression predicted a rate of CD4 decline over the ensuing 4 years that was 50% greater than among non-depressed men, independently of established markers for HIV disease progression. There was also a trend toward greater mortality, despite no observable effect on progression to AIDS. The mechanism of any effect of depression on immunologic deterioration remains unexplained. Treating depression improves quality of life. Clinical studies should investigate whether it can also slow HIV disease progression and prolong life.

Keywords: AEGIS, Homosexuality, Male, Antigens, CD4, CD4 Lymphocyte Count, Acquired Immunodeficiency Syndrome, HIV Infections, HIV Seropositivity, Bisexuality, Depression, HIV, HIV Core Protein p24, HIV Antigens, Disease Progression, Prospective Studies, Mood Disorders, beta 2-Microglobulin, San Francisco, Zidovudine, Human, Male, ICA8
920719
WeC1031