Association Between Race, Depression, and Antiretroviral Therapy Adherence in a Low-Income Population with HIV Infection
- 366 Downloads
Racial disparities exist in many aspects of HIV/AIDS. Comorbid depression adds to the complexity of disease management. However, prior research does not clearly show an association between race and antiretroviral therapy (ART) adherence, or depression and adherence. It is also not known whether the co-existence of depression modifies any racial differences that may exist.
To examine racial differences in ART adherence and whether the presence of comorbid depression moderates these differences among Medicaid-enrolled HIV-infected patients.
Retrospective cohort study.
Multi-state Medicaid database (Thomson Reuters MarketScan®).
Data for 7,034 HIV-infected patients with at least two months of antiretroviral drug claims between 2003 and 2007 were assessed.
Antiretroviral therapy adherence (90 % days covered) were measured for a 12-month period. The main independent variables of interest were race and depression. Other covariates included patient variables, clinical variables (comorbidity and disease severity), and therapy-related variables.
In this study sample, over 66 % of patients were of black race, and almost 50 % experienced depression during the study period. A significantly higher portion of non-black patients were able to achieve optimal adherence (≥90 %) compared to black patients (38.6 % vs. 28.7 %, p < 0.001). In fact, black patients had nearly 30 % decreased odds of being optimally adherent to antiretroviral drugs compared to non-black patients (OR = 0.70, 95 % CI: 0.63–0.78), and was unchanged regard less of whether the patient had depression. Antidepressant treatment nearly doubled the odds of optimal ART adherence among patients with depression (OR = 1.92, 95 % CI: 1.12–3.29).
Black race was significantly associated with worse ART adherence, which was not modified by the presence of depression. Under-diagnosis and under-treatment of depression may hinder ART adherence among HIV-infected patients of all races.
KEY WORDSHIV adherence depression race Medicaid
- 6.Palacio H, Kahn JG, Richards TA, et al. Effect of race and/or ethnicity in use of antiretrovirals and prophylaxis for opportunistic infection: a review of the literature. Public Health Reports (Washington, DC: 1974), June 2002. 117(3):233–251; discussion 231–232.Google Scholar
- 7.CDC. HIV/AIDS Surveillance Report, 2007. Vol. 19. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Available at http://www.cdc.gov/hiv/surveillance/resources/reports/2007report/index.htm. Accessed February 20, 2012.
- 8.Heron M, Hoyert DL, Murphy SL, et al. Deaths: final data for 2006. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2009. National Vital Statistics Report, vol. 57, no. 14. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf. Accessed February 20, 2012.
- 11.Li X, Margolick JB, Conover CS, et al. Interruption and discontinuation of highly active antiretroviral therapy in the multicenter AIDS cohort study. JIDS. 2005;38:320–328.Google Scholar
- 33.Perinatal HIV Guidelines Working Group. Public Health Service Task Force Recommendations for use of antiretroviral drugs in pregnant HIV-infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States. Jul 8, 2008. pp. 1–98. Available at http://aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf. Accessed February 20, 2012.
- 34.CDC. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm. Accessed February 20, 2012.