AIDSWEEKLY Plus; July 29, 2002
Michael Greer, Senior Medical Writer

In a study published in the July 2002 issue of the Journal of General and Internal Medicine, a research team found that those HIV patients who experience more symptoms - regardless of how depressed they may or may not be - are the ones more likely to die within the coming year. Physicians who may be tempted to dismiss symptoms reported by a patient with HIV who is depressed, the study indicated, are missing the bigger picture.

"Providers may want to give equal consideration to clinical symptoms presented by HIV-infected patients, regardless of their depression status," observed lead author Amy M. Kilbourne, PhD, MPH, of the VA Pittsburgh Center for Health Equity Research and Promotion.

Kilbourne explained that practitioners have long been aware that depressed patients with HIV disease report more symptoms than nondepressed patients with HIV disease.

"Yet clinicians are given little guidance as to what to do in response to symptoms reported by depressed patients," she noted. "Should clinicians first treat the depression and observe whether the [symptom] resolves, or should they also search for the medical causes of the symptom?"

To answer those questions, Kilbourne and her colleagues used data from a large-scale study of HIV patients treated at Veterans Administration Medical Centers in Cleveland, Houston and Manhattan between June 1999 and July 2000. The investigators surveyed all willing patients and reviewed their medical records in order to determine the severity of their illness, the nature and number of their HIV symptoms and how bothersome those symptoms were. At the same time, the researchers assessed each participant's level of depression. The team followed the medical progress of each of the 881 participants during the following year.

At the 1-year mark, the authors found, those patients who had begun the study with the highest number of HIV disease symptoms were more likely to be among the 53 participants who died.

Because severe depression and serious symptoms often went hand in hand, a finding consistent with previous research, many of those who died had been severely depressed when first interviewed. However, data analysis revealed that the severity of a patient's symptoms - regardless of level of depression - was the strongest predictor of whether that person would live or die in the coming year.

"Our findings...are of potential clinical importance," Kilbourne concluded. "In a [prior] survey of over 200 [primary care] providers...providers were less likely to believe that a patient with a prior psychiatric history who presented a new symptom had a potentially serious physical illness. This is perhaps due to the provider's perception that patients with depression exaggerate their physical symptoms."

The present study, she noted, indicates that such assumptions are not supported. Thus, although Kilbourne by no means advised ignoring psychological distress, she did warn against treating the medical symptoms of HIV any differently in patients who are and are not depressed.

Funding for the study was provided by the U.S. National Institute of Aging, the Robert Wood Johnson Foundation, the National Institute of Mental Health and the Department of Veterans Affairs.

This article was prepared by AIDS Weekly editors from staff and other reports.

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