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Psychiatric Quarterly
Published in: Psychiatric Quarterly 1/2008

01-03-2008 | Original Paper

Antidepressant Treatment and Adherence to Combination Antiretroviral Therapy among Patients with AIDS and Diagnosed Depression

Authors: James Walkup, Wenhui Wei, Usha Sambamoorthi, Stephen Crystal

Published in: Psychiatric Quarterly | Issue 1/2008

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Abstract

Background

The prevalence of depression is elevated among HIV-infected individuals and there is evidence that depression exerts a negative impact on HIV medication adherence.

Methods

Merged HIV/AIDS surveillance data and Medicaid claims data from January 1996 to December 1998 were used to identify AIDS-infected patients with diagnosed depression, and filled prescriptions were used to identify their antidepressant use, and highly active antiretroviral therapy (HAART). Chi-square tests and robust logistic regressions were used to examine antidepressant use after HAART initiation, and a person-month approach was used to estimate the association between antidepressant treatment and adherence to HAART after its initiation.

Results

Of the 406 AIDS-infected patients diagnosed with depression who initiated HAART during this period, 81% (N = 329) were treated with an antidepressant. The HAART adherence rate was low overall. After HAART initiation; only 63% of the person-months had a prescription for it. However, use of an antidepressant in the prior month was significantly associated with HAART in the current month. After controlling for other factors, the odds of current-month HAART adherence were increased by almost 30% for those with antidepressant use in the prior month (Adjusted OR = 1.28, 95% CI [1.16, 1.41]).

Conclusions

While the HAART adherence rate was low among patients with AIDS diagnosed with depression, prior month’s antidepressant use increases odds of adherence. Unmeasured factors may influence the reported association between antidepressant use and HAART adherence, but our findings point to the need to investigate directly the impact of antidepressant therapy on HAART adherence found among patients with AIDS and depression.
Literature
1.
Komiti A, Judd F, Grech P, Mijch A, Hoy J, Williams B, et al.: Depression in people living withHIV/AIDS attending primary care and outpatient clinics. Australian and New Zealand Journal of Psychiatry 37:70–77, 2003PubMedCrossRef
2.
Rabkin JG: Prevalence of psychiatric disorders in HIV illness. International Review of Psychiatry 8(2–3):157–166, 1996CrossRef
3.
Stober D, Schwartz J, McDaniel J, Abrams R: Depression and HIV disease: Prevalence, correlates, and treatment. Psychiatric Annals 27:372–377, 1997
4.
Rabkin JG, Rabkin R, Harrison W, Wagner G: Effect of imipramine on mood and enumerative measures of immune status in depressed patients with HIV illness. American Journal of Psychiatry 151:516–523, 1994PubMed
5.
Rosenberger PH, Bornstein RA, Nasrallah HA, Para MF, Whitaker CC, Fass RJ, Rice RR: Psychopathology in human immunodeficiency virus infection: Lifetime and current assessment. Comprehensive Psychiatry 34:150–158, 1993PubMedCrossRef
6.
Ciesla JA, Roberts JE: Meta-analysis of the relationship between HIV infection and risk for depressive disorders. American Journal of Psychiatry 158:725–730, 2001PubMedCrossRef
7.
Dew MA, Becker JT, Sanchez J, Caldararo R, Lopez OL, Wess J, et al.: Prevalence and predictors of depressive, anxiety and substance use disorders in HIV-infected and uninfected men: A longitudinal evaluation. Psychological Medicine 27:395–409, 1997PubMedCrossRef
8.
Gordillo V, del Amo J, Soriano V, Gonzalez-Lahoz J: Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS 13:1763–1769, 1999PubMedCrossRef
9.
Singh N, Squier C, Sivek C, Wagener M, Nguyen MH, Yu VL: Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: prospective assessment with implications for enhancing compliance. AIDS Care 8:261–269, 1996PubMedCrossRef
10.
Starace F, Ammassari A, Trotta MP, DeLongis P, Izzo C, Scalzini A, et al.: Depression is a risk factor for suboptimal adherence to highly active antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes 31 (suppl 3):136–139, 2002
11.
Carrieri MP, Leport C, Protopopescu C, Cassuto J, Bouvet E, Peyramond D, Raffi F, Moatti J, Chene G, Spire B: Factors associated with nonadherence to highly active antiretroviral therapy: A 5-year follow-up analysis with correction for the bias induced by missing data in the treatment maintenance phase. Journal of Acquired Immune Deficiency Syndromes 41:477–485, 2006PubMedCrossRef
12.
Cook JA: Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV-seropositive women. Journal of Acquired Immune Deficiency Syndromes 30:401–409, 2002PubMed
13.
Li X, Margolick J, Conover C, Badri S, Riddler S, Witt M, Jacobson L: Interruption and discontinuation of highly active antiretroviral therapy in the multicenter AIDS cohort study. Journal of Acquired Immune Deficiency Syndromes 38:314–319, 2005
14.
Sledjeski EM, Delahanty DL, Bogart LM: Incidence and impact of posttraumatic stress disorder and comorbid depression on adherence to HAART and CD4-super (+) counts in people living with HIV. AIDS Patient Care and STDs 19:728–736, 2005PubMedCrossRef
15.
Boarts JM, Sledjeski EM, Bogart LM, Delahanty DL: The differential impact of PTSD and depression on HIV disease markers and adherence to HAART in people living with HIV. AIDS and Behavior 10:253–261, 2006PubMedCrossRef
16.
Walkup J, Sambamoorthi U, Crystal S: Initiation and continuation of newer antiretroviral treatments among Medicaid beneficiaries with severe mental illness and AIDS. Journal of Clinical Psychiatry 65:1180–1189, 2004PubMedCrossRef
17.
Turner BJ, Laine C, Cosler L, Hauck WW: Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users. Journal of General Internal Medicine 18: 248–257, 2003PubMedCrossRef
18.
Elliott AJ, Uldall KK, Bergam K, Russo J, Claypoole K, Roy-Byrne PP: Randomized, placebo-controlled trial of paroxetine versus imipramine in depressed HIV-positive outpatients. American Journal of Psychiatry 155:367–372, 1998PubMed
19.
Zisook S, Peterkin J, Goggin KJ, Sledge P, Atkinson JH, Grant I: Treatment of major depression in HIV-seropositive men. HIV neurobehavioral research center group. Journal of Clinical Psychiatry 59:217–224, 1998PubMed
20.
Markowitz JC, Klerman GL, Clougherty KF, Spielman LA, Jacobsberg LB, Fishman B, et al.: Individual psychotherapies for depressed HIV-positive patients. American Journal of Psychiatry 152:1504–1509, 1995PubMed
21.
Himelhoch S, Medoff DR: Efficacy of antidepressant medication among HIV-positive individuals with depression: a systematic review and meta-analysis. AIDS Patient Care STDS 19:813–822, 2005PubMedCrossRef
22.
Cook JA, Grey D, Burke-Miller MH, Cohen MH, Anastos K, et al.: Effects of treated and untreated depressive symptoms on highly active antiretroviral therapy use in a US multi-site cohort of HIV-positive women. AIDS Care 18:93–100, 2006PubMedCrossRef
23.
Yun L, Maravi M, Kobayashi JS, Barton PL, Davidson AJ: Antidepressant treatment improves adherence to antiretroviral therapy among depressed HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes 38:432–438, 2005PubMedCrossRef
24.
Wilson IB, Jacobson D: Regarding: “Antidepressant treatment improves adherence to antiretroviral therapy among depressed HIV-infected patients”. Journal of Acquired Immune Deficiency Syndromes 41:254–255, 2006PubMedCrossRef
25.
Brechtl JR, Breitbart W, Galietta M, Krivo S, Rosenfeld B: The use of highly active antiretroviral therapy (HAART) in patients with advanced HIV infection: impact on medical, palliative care, and quality of life outcomes. Journal of Pain and Symptom Management 21:41–51, 2001PubMedCrossRef
26.
Judd FK, Cockram AM, Komiti A, Mijch AM, Hoy J, Bell R: Depressive symptoms reduced in individuals with HIV/AIDS treated with highly active antiretroviral therapy: A longitudinal study. Australian and New Zealand Journal of Psychiatry 34:1015–1021, 2000PubMed
27.
Low-Beer S, Chan K, Yip B, et al.: Depressive symptoms among persons on HIV protease inhibitors. Journal of Acquired Immunodeficiency Syndrome 23:295–301, 2000
28.
Howard A, Arnsten JH, Lo Y, Vlahov D, Rich JD, Schuman P, Stone VE, Smith DK, Schoenbaum E, for the HER Study Group: A prospective study of adherence and viral load in a large multi-center cohort of HIV-infected women. AIDS 16:2175–2182, 2002PubMedCrossRef
29.
New Jersey DHSS: New Jersey HIV/AIDS Cases Reported as of December 31, 1996: Divison of AIDS Prevention and Control, New Jersey Department of Health and Senior Servies, Trenton, 1997
30.
Sambamoorthi U, Collins S, Crystal S: Dually eligible individuals with AIDS: Characteristics, health services use. Journal of Health Social Policy 14(1):19–35, 2001PubMedCrossRef
31.
Merzel C, Crystal S, Sambamoorthi U, Karus D, Kurland C: New Jersey’s Medicaid waiver for acquired immunodeficiency syndrome. Health Care Financing Review 13(3):27–44, 1992PubMed
32.
Sambamoorthi U, Moynihan PJ, McSpiritt E, Crystal S: Use of protease inhibitors and non-nucleoside reverse transcriptase inhibitors among Medicaid beneficiaries with AIDS. American Journal of Public Health 91(9):1474–1481, 2001PubMedCrossRef
33.
Fairfield KM, Libman H, Davis RB, Eisenberg DM: Delays in protease inhibitor use in clinical practice. Journal of General Internal Medicine 14:395–401, 1999PubMedCrossRef
34.
Bogart LM, Kelly JA, Catz SL, Sosman JM: Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment. Journal of Acquired Immune Deficiency Syndrome 23:396–404, 2000
35.
StataCorp. Stata Statistical Software (Version 8.2). College Station, TX: Stata Corporation, 2004
36.
Himelhoch S, Moore R, Treisman G, Kelly A: Does the presence of a current psychiatric disorder in AIDS patients affect the initiation of antiretroviral treatment and duration of therapy? Journal of Acquired Immune Deficiency Syndromes 37:1457–1463, 2004PubMedCrossRef
37.
Klinkenberg WD, Sacks S: Mental disorders and drug abuse in people living with HIV/AIDS. AIDS Care, 16(suppl 1):22–42, 2004CrossRef
38.
Skaer TL, Sclar DA, Robison LM, Galin RS: Trends in the rate of depressive illness and use of antidepressant pharmacotherapy by ethnicity/race: an assessment of office-based visits in the United States, 1992–1997. Clinical Therapeutics 22:1575–1589, 2000PubMedCrossRef
39.
Harman J, Fortney J, Edlund M: Disparities in the adequacy of depression care in the United States. Psychiatric Services 55:1379–1385, 2004PubMedCrossRef
40.
Asch SM, Kilbourne AM, Gifford AL, Burnam MA, Turner B, Shapiro MF, Bozzette SA, For the HCSUS Consortium: Underdiagnosis of depression in HIV: Who are we missing? Journal of General Internal Medicine 18:450–460, 2003PubMedCrossRef
41.
Walkup J, Boyer C, Kellermann S: Reliability of Medicaid claims files for use in psychiatric diagnosis and service delivery. Administration and Policy in Mental Health 27:129–139, 2000PubMedCrossRef
42.
Steiner JF, Prochazka AV: The assessment of refill compliance using pharmacy records: Methods, validity, and application. Journal of Clinical Epidemiology 50:105–116, 1997PubMedCrossRef
43.
Safran SA, Otto MW, Worth J, et al.: Two strategies to increase adherence to HIV antiretroviral medication: Life-steps and medication monitoring. Behavioral Research and Therapy 39: 1151–1162, 2001CrossRef
Metadata
Title
Antidepressant Treatment and Adherence to Combination Antiretroviral Therapy among Patients with AIDS and Diagnosed Depression
Authors
James Walkup
Wenhui Wei
Usha Sambamoorthi
Stephen Crystal
Publication date
01-03-2008
Publisher
Springer US
Published in
Psychiatric Quarterly / Issue 1/2008
Print ISSN: 0033-2720
Electronic ISSN: 1573-6709
DOI
https://doi.org/10.1007/s11126-007-9055-x

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