Risk of clinically significant depression in HIV-infected patients: effect of antiretroviral drugs†
Article first published online: 11 NOV 2013
© 2013 British HIV Association
Volume 15, Issue 4, pages 213–223, April 2014
How to Cite
Gutiérrez, F., García, L., Padilla, S., Álvarez, D., Moreno, S., Navarro, G., Gómez-Sirvent, J., Vidal, F., Asensi, V., Masiá, M. and CoRIS (2014), Risk of clinically significant depression in HIV-infected patients: effect of antiretroviral drugs. HIV Medicine, 15: 213–223. doi: 10.1111/hiv.12104
Presented in part at the 20th Conference on Retroviruses and Opportunistic Infections, Atlanta, GA, 3-6 March 2013 [Abstract 413].
- Issue published online: 3 MAR 2014
- Article first published online: 11 NOV 2013
- Manuscript Accepted: 17 SEP 2013
- Red Temática de Investigación Cooperativa en VIH/SIDA-ISC III-RETIC. Grant Numbers: RD06/0027, RD12/0017/0023
- Instituto de Salud Carlos III-FIS. Grant Number: PI081893
- antiretroviral therapy;
- neurologic complications;
- non-AIDS events;
- psychiatric events
We aimed to characterize depression in newly diagnosed HIV-infected patients, to determine the effect of antiretroviral therapy (ART) on its incidence, and to investigate whether efavirenz use was associated with a higher risk, compared with non-efavirenz-containing regimens, in the Spanish CoRIS cohort.
CoRIS is a contemporary, multicentre cohort of HIV-infected patients, antiretroviral-naïve at entry, launched in 2004. Poisson regression models were used to investigate demographic, clinical and treatment-related factors associated with a higher incidence of clinically significant depression to October 2010.
In total, 5185 patients (13 089 person-years) participated in the study, of whom 3379 (65.2%) started ART during follow-up. The incidence rates of depression before and after starting ART were 11.68 [95% confidence interval (CI) 9.01–15.15] and 7.06 (95% CI 5.45–9.13) cases per 1000 person-years, respectively. After adjustment, there was an inverse association between the occurrence of depression and the initiation of ART [incidence rate ratio (IRR) 0.53; 95% CI 0.28–0.99], while the likelihood of depression increased in patients of age > 50 years (IRR 1.94; 95% CI 1.21–3.12). Longer exposure to ART was associated with a decreased IRR of depression in unadjusted and adjusted analyses. The IRR for patients receiving < 2, 2–4 and > 4 years of ART was 0.72 (95% CI 0.36–1.44), 0.10 (95% CI 0.04–0.25) and 0.05 (95% CI 0.01–0.17), respectively, compared with ART-naïve patients. This protective effect was also observed when durations of exposure to nonnucleoside reverse transcriptase inhibitor-based regimens and efavirenz-containing regimens were analysed separately.
The incidence of clinically significant depression was lower among HIV-infected patients on ART. The protective effect of ART was also observed with efavirenz-containing regimens.