Prevalence of treated and untreated depression in a cohort of HIV+ women: Impact on antiretroviral therapy utilization and HIV disease outcomes

Background: The prevalence of depressive disorders (DD) was assessed in a multi-site cohort of Women's Interagency HIV Study (WIHS) HIV+ participants. We hypothesized that: 1) DD prevalence would be higher than among women in the general population; and 2) those with treated DD would be more likely than untreated women to be on highly active antiretroviral therapy (HAART), and have better HIV disease outcomes.

Methods: 889 women were assessed using the World Mental Health Composite International Diagnostic Interview. Prevalence and treatment of major depressive disorder (MDD), dysthymia, and minor depressive disorder (mDD) were calculated and matched to 12-month data regarding HAART utilization, plasma HIV-RNA (>1,000), and CD4 (<200 copies/ml). Logistic regression analysis controlled for age, race/ethnicity, income, and education.

Results: MDD 12-month prevalence was 18%, dysthymia 9% and mDD 2%; all were double the proportions found in the adult female population in the U.S. National Co-morbidity Survey-Replication. DD treatment prevalence was 73%. Those with treated DD were significantly more likely than those with untreated DD to be receiving HAART (O.R.=3.21, C.I.=1.29-8.00); there no relationship with adherence. Those with treated DD were significantly more likely than untreated counterparts to have controlled viral loads (O.R.=0.37, C.I.=0.17-0.82), despite controlling for use of HAART, age, race/ethnicity, education, and income. No relationship between treated DD and CD4 was observed.

Conclusions: Depression is highly prevalent among HIV+ women but many depressed women report receiving treatment. Treated women are more likely to be on HAART and to have controlled viral loads regardless of their use of HAART.