Do Symptoms of Depression Interact with Substance Use to Affect HIV Continuum of Care Outcomes?
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Few studies examine how depression and substance use interact to affect HIV control. In 14,380 persons with HIV (PWH), we used logistic regression and generalized estimating equations to evaluate how symptoms of depression interact with alcohol, cocaine, opioid, and methamphetamine use to affect subsequent retention in care, maintaining an active prescription for ART, and consistent virologic suppression. Among PWH with no or mild depressive symptoms, heavy alcohol use had no association with virologic suppression (OR 1.00 [0.95–1.06]); among those with moderate or severe symptoms, it was associated with reduced viral suppression (OR 0.80 [0.74–0.87]). We found no interactions with heavy alcohol use on retention in care or maintaining ART prescription or with other substances for any outcome. These results highlight the importance of treating moderate or severe depression in PWH, especially with comorbid heavy alcohol use, and support multifaceted interventions targeting alcohol use and depression.
KeywordsAlcohol HIV Depression Illicit drug use Viral suppression
This work was supported by two NIAAA Research Grants (U01 AA020793, U24 AA020801).
Compliance with Ethical Standards
Conflict of interest
Anthony T. Fojo, Catherine R. Lesko, Keri L. Calkins, Richard D. Moore, Mary E. McCaul, Heidi E. Hutton, William C. Mathews, Heidi Crane, Karen Cropsey, Michael J. Mugavero, Kenneth Mayer, Brian W. Pence, Bryan Lau, and Geetanjali Chander declares that they have no conflict of interest. Katerina Christopoulos has been scientific advisory board member for Roche Pharmaceuticals and a community advisory board member for Gilead Sciences Inc.
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 12.Horberg MA, Silverberg MJ, Hurley LB, Towner WJ, Klein DB, Bersoff-Matcha S, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr. 2008;47(3):384–90.CrossRefPubMedGoogle Scholar
- 16.Barfod TS, Gerstoft J, Rodkjaer L, Pedersen C, Nielsen H, Moller A, et al. Patients’ answers to simple questions about treatment satisfaction and adherence and depression are associated with failure of HAART: a cross-sectional survey. AIDS Patient Care STDS. 2005;19(5):317–25.CrossRefPubMedGoogle Scholar
- 17.Ironson G, O’Cleirigh C, Fletcher MA, Laurenceau JP, Balbin E, Klimas N, et al. Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med. 2005;67(6):1013–21.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Rasbach DA, Desruisseau AJ, Kipp AM, Stinnette S, Kheshti A, Shepherd BE, et al. Active cocaine use is associated with lack of HIV-1 virologic suppression independent of nonadherence to antiretroviral therapy: use of a rapid screening tool during routine clinic visits. AIDS Care. 2013;25(1):109–17.CrossRefPubMedGoogle Scholar
- 36.Himelhoch S, Chander G, Fleishman JA, Hellinger J, Gaist P, Gebo KA. Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use. Gen Hosp Psychiatry. 2007;29(6):518–25.CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Azar P, Wood E, Nguyen P, Luma M, Montaner J, Kerr T, et al. Drug use patterns associated with risk of non-adherence to antiretroviral therapy among HIV-positive illicit drug users in a Canadian setting: a longitudinal analysis. BMC Infect Dis. 2015;15(1):193.CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Braithwaite RS, Fang Y, Tate J, Mentor SM, Bryant KJ, Fiellin DA, et al. Do alcohol misuse, smoking, and depression vary concordantly or sequentially? A longitudinal study of HIV-infected and matched uninfected veterans in care. AIDS Behav. 2016;20(3):566–72.CrossRefPubMedPubMedCentralGoogle Scholar
- 45.Ruggles KV, Fang Y, Tate J, Mentor SM, Bryant KJ, Fiellin DA, et al. What are the patterns between depression, smoking, unhealthy alcohol use, and other substance use among individuals receiving medical care? A longitudinal study of 5479 participants. AIDS Behav. 2017;21(7):2014–22.CrossRefPubMedPubMedCentralGoogle Scholar
- 56.Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.CrossRefPubMedGoogle Scholar
- 59.National Institute on Drug Abuse (NIDA). Clinician’s Screening Tool for Drug Use in General Medical Settings; 2010. https://www.drugabuse.gov/nmassist/.
- 60.Ford MA, Spicer CM, Institute of Medicine (U.S.). Committee to review data systems for monitoring HIV care. Monitoring HIV care in the United States: indicators and data systems. Washington, DC: National Academies Press; 2012.Google Scholar
- 67.Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. In: Department of Health and Human Services, editor.Google Scholar
- 70.Hanna DB, Buchacz K, Gebo KA, Hessol NA, Horberg MA, Jacobson LP, et al. Trends and disparities in antiretroviral therapy initiation and virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001–2009. Clin Infect Dis. 2013;56(8):1174–82.CrossRefPubMedPubMedCentralGoogle Scholar
- 76.Rubin DB. Multiple imputation for nonresponse in surveys. Hoboken, NJ: Wiley; 2004.Google Scholar
- 83.R Core Team. R: a language and environment for statistical computing. Vienna, Austria; 2014.Google Scholar
- 86.Fox J, Weisberg S, Fox J. An R companion to applied regression. 2nd ed. Thousand Oaks: Sage; 2011.Google Scholar
- 87.Chilcot J, Chin WY, Choi EPH, Chan KTY, Wong CKH. The psychometric properties of the center for epidemiologic studies depression scale in Chinese primary care patients: factor structure, construct validity, reliability, sensitivity and responsiveness. PLoS ONE. 2015;10(8):e0135131.CrossRefGoogle Scholar
- 103.O’Cleirigh C, Newcomb ME, Mayer KH, Skeer M, Traeger L, Safren SA. Moderate levels of depression predict sexual transmission risk in HIV-infected MSM: a longitudinal analysis of data from six sites involved in a “prevention for positives” study. AIDS Behav. 2013;17(5):1764–9.CrossRefPubMedPubMedCentralGoogle Scholar