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Improvement in depressive symptoms after antiretroviral therapy initiation in people with HIV in Rakai, Uganda

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Abstract

Depression is common following HIV infection and often improves after ART initiation. We aimed to identify distinct dimensions of depression that change following ART initiation in persons with HIV (PWH) with minimal comorbidities (e.g., illicit substance use) and no psychiatric medication use. We expected that dimensional changes in improvements in depression would differ across PWH. In an observational cohort in Rakai, Uganda, 312 PWH (51% male; mean age = 35.6 years) completed the Center for Epidemiologic Studies–Depression (CES-D) scale before and up to 2 years after ART initiation. Twenty-two percent were depressed (CES-D scores ≥ 16) pre-ART that decreased to 8% after ART. All CES-D items were used in a latent class analysis to identify subgroups with similar change phenotypes. Two improvement phenotypes were identified: affective-symptom improvement (n = 58, 19%) and mixed-symptom improvement (effort, appetite, irritability; n = 41, 13%). The affect-improvement subgroup improved on the greatest proportion of symptoms (76%). A third subgroup was classified as no-symptom changes (n = 213, 68%) as they showed no difference is symptom manifestation from baseline (93% did not meet depression criteria) to post-ART. Factors associated with subgroup membership in the adjusted regression analysis included pre-ART self-reported functional capacity, CD4 count, underweight BMI, hypertension, female sex(P’s < 0.05). In a subset of PWH with CSF, subgroup differences were seen on Aβ-42, IL-13, and IL-12. Findings support that depression generally improves following ART initiation; however, when improvement is seen the patterns of symptom improvement differ across PWH. Further exploration of this heterogeneity and its biological underpinning is needed to evaluate potential therapeutic implications of these differences.

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Acknowledgments

Dr. Kevin Robertson contributed to the conceptualization, conduction, supervision, and analysis if this study sadly passed on before the final draft of the manuscript. We would also like to thank Dr. Raha Dastgheyb for helping us to create Fig. 3 and Dr. Robert Paul for his insight into addressing the second round of revisions. We would also like to thank the participants and staff of the Rakai Health Sciences Program for their time and effort in the successful conduction of this study.

Funding

This study was sponsored by the NIH (MH120693; MH099733, MH075673, MH080661, L30NS088658, NS065729-05S2) with additional funding from the Johns Hopkins Center for Global Health. This study was also supported in part by the Division of Intramural Research, NIAID, NIH.

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  1. Noeline Nakasujja and Alyssa C. Vecchio contributed equally in this article.

Authors and Affiliations

  1. Department of Psychiatry, Makerere University, Kampala, Uganda

    Noeline Nakasujja

  2. Institute of Global Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA

    Alyssa C. Vecchio

  3. Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Meyer 6-113, Baltimore, MD, USA

    Deanna Saylor, Carlos A. Pardo, Ned Sacktor & Leah H. Rubin

  4. Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA

    Sarah Lofgren

  5. Rakai Health Sciences Program, Kalisizo, Uganda

    Gertrude Nakigozi, Alice Kisakye, James Batte, Richard Mayanja, Aggrey Anok & Anupama Kumar

  6. Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA

    Steven J. Reynolds & Thomas C. Quinn

  7. Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Steven J. Reynolds & Thomas C. Quinn

  8. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    Ronald H. Gray, Maria J. Wawer & Leah H. Rubin

  9. Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, USA

    Leah H. Rubin

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  1. Noeline Nakasujja
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Nakasujja, N., Vecchio, A.C., Saylor, D. et al. Improvement in depressive symptoms after antiretroviral therapy initiation in people with HIV in Rakai, Uganda. J. Neurovirol. 27, 519–530 (2021). https://doi.org/10.1007/s13365-020-00920-6

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