Researchers reported results on 765 HIV positive women who made regular visits to study clinics so that their health could be assessed. Researchers began recruitment between 1993 and 1995. Monitoring continued until March 2000. Thus, in some cases, researchers collected up to seven years of data. Subjects had the following profile at the start of the study:
During the study the following drugs were used by the proportion of women indicated:
During the study, subjects admitted to the following activities with the drugs listed:
Most women in the study (54%) denied using any of the above drugs.
During the study, the following degrees of depression affected the proportion of women indicated:
During the study 14% (106) of the women died from HIV-related causes (these were not specified by the researchers). Within each type of depression, the following proportion of women died:
The differences between the three groups were statistically significant, that is, not likely due to chance alone.
The researchers also found that subjects who were 35 years or older were 1.5 times more likely to die than younger subjects. As well, women who were unemployed were twice as likely to die compared to those who were employed.
Researchers matched categories of depression and CD4+ counts to find out the impact of each on the survival of women in the study.
Among women who had fewer than 200 CD4+ cells and the following categories of depression, the proportion who died was as follows:
These differences were statistically significant.
Among women who had between 200 and 500 CD4+ cells and the following categories of depression, the proportion who died was as follows:
These differences in death rates were not significant although there is a trend for an increased risk of death as depression becomes more serious.
Among women who had more than 500 CD4+ cells there was no significant difference in death rates for the three categories of depression.
The researchers noted that those subjects who had chronic or intermittent depression had a larger decline in CD4+ counts over the course of the study compared with women who had only a limited number or no symptoms of depression. This difference was statistically significant.
Women with the following profile in the study also had a relatively high loss of CD4+ cells:
Just as depression influenced the loss of CD4+ cells, it also affected the amount of virus in the blood — viral load. Women with chronic depression were more likely to have higher viral loads than women with few or no symptoms of depression.
According to the researchers, "Determining a clear cause-and-effect relationship between depression and HIV disease progression is complex because symptoms for both conditions overlap."
Nonetheless, the researchers suggested that depressive illness "contributes uniquely [to death and is not simply a result] of declining health."
Depression may indirectly influence health by changing levels of hormones in the brain, which weaken the immune system and directly weaken immunity through contact between a depressed brain and cells of the immune system.
Depression can also cause problems in other ways:
The results of this study should highlight the importance of depression in HIV positive women to health care providers so that they can identify women at risk for depression, monitor them and offer them treatment or therapy for this condition. In the research field, more work needs to be done to develop novel antidepressants that work faster and have fewer side effects and drug interactions than currently licensed therapies. And, last but not least, women with HIV and their family members need to be educated about depression and its symptoms.
REFERENCE
Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, CD4 count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV epidemiology research study. Journal of the American Medical Association 2001;285(11):1466-1474.
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Copyright © 2001 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284 http://www.catie.ca.
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