Annals of Behavioral Medicine

, Volume 47, Issue 3, pp 259–269 | Cite as

Depression Treatment Enhances Adherence to Antiretroviral Therapy: a Meta-Analysis

Original Article



Depression is a risk factor for nonadherence to HIV/AIDS treatment.


A meta-analysis was conducted to examine whether treatment of depression and psychological distress improves antiretroviral therapy adherence.


PubMed and PsycINFO databases were systematically searched for relevant articles. Studies that reported an association between depression treatment (or an intervention with a component addressing mental health) and antiretroviral adherence were included.


Across 29 studies of 12,243 persons living with HIV/AIDS, treatment of depression and psychological distress improved antiretroviral adherence (p < 0.001). The odds of a person adhering were 83 % better if he/she was treated for depression. Greater improvements in adherence were found for samples with lower CD4 counts or more severe depression, for interventions specifically targeting depression (versus addressing mental health as a secondary objective), longer treatments, and observational studies.


These findings support the need for detection and treatment of depression among persons living with HIV/AIDS.


Depression HIV/AIDS Adherence Compliance Antiretroviral therapy Meta-analysis 

Supplementary material

12160_2013_9559_MOESM1_ESM.doc (148 kb)
ESM 1(DOC 148 kb)


  1. 1.
    Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001; 58(8): 721-728.PubMedCrossRefGoogle Scholar
  2. 2.
    Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001; 158(5): 725-730.PubMedCrossRefGoogle Scholar
  3. 3.
    Burack JH, Barrett DC, Stall RD, Chesney MA, Ekstrand ML, Coates TJ. Depressive symptoms and CD4 lymphocyte decline among HIV-infected men. J Am Med Assoc. 1993; 270(21): 2568-2573.CrossRefGoogle Scholar
  4. 4.
    Hartzell JD, Janke IE, Weintrob AC. Impact of depression on HIV outcomes in the HAART era. J Antimicrob Chemother. 2008; 62(2): 246-255.PubMedCrossRefGoogle Scholar
  5. 5.
    Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women. J Am Med Assoc. 2001; 285(11): 1466-1474.CrossRefGoogle Scholar
  6. 6.
    Mayne TJ, Vittinghoff E, Chesney MA, Barrett DC, Coates TJ. Depressive affect and survival among gay and bisexual men infected with HIV. Arch Intern Med. 1996; 156(19): 2233-2238.PubMedCrossRefGoogle Scholar
  7. 7.
    Page-Shafer K, Delorenze GN, Satariano WA, Winkelstein W. Comorbidity and survival in HIV-infected men in the San Francisco Men's Health Survey. Ann Epidemiol. 1996; 6(5): 420-430.PubMedCrossRefGoogle Scholar
  8. 8.
    DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000; 160(14): 2101-2107.PubMedCrossRefGoogle Scholar
  9. 9.
    Grenard JL, Munjas BA, Adams JL, et al. Depression and medication adherence in the treatment of chronic diseases in the United States: A meta-analysis. J Gen Intern Med. 2011; 26(10): 1175-1182.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: A review and meta-analysis. J Acquir Immune Defic Syndr. 2011; 58(2): 181-187.PubMedGoogle Scholar
  11. 11.
    Wagner GJ, Goggin K, Remien RH, et al. A closer look at depression and its relationship to HIV antiretroviral adherence. Ann Behav Med. 2011; 42(3): 352-360.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Mannheimer S, Friedland G, Matts J, Child C, Chesney M. The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus-infected persons in clinical trials. Clin Infect Dis. 2002; 34(8): 1115-1121.PubMedCrossRefGoogle Scholar
  13. 13.
    Nachega JB, Hislop M, Dowdy DW, Chaisson RE, Regensberg L, Maartens G. Adherence to nonnucleoside reverse transcriptase inhibitor-based HIV therapy and virologic outcomes. Ann Intern Med. 2007; 146(8): 564.PubMedCrossRefGoogle Scholar
  14. 14.
    Nieuwkerk PT, Oort FJ. Self-reported adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response: A meta-analysis. J Acquir Immune Defic Syndr. 2005; 38(4): 445-448.PubMedCrossRefGoogle Scholar
  15. 15.
    Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000; 133(1): 21-30.PubMedCrossRefGoogle Scholar
  16. 16.
    Lima VD, Harrigan R, Bangsberg DR, et al. The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time. J Acquir Immune Defic Syndr. 2009; 50(5): 529-536.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Ortego C, Huedo-Medina TB, Llorca J, et al. Adherence to highly active antiretroviral therapy (HAART): A meta-analysis. AIDS Behav. 2011; 15(7): 1381-1396.PubMedCrossRefGoogle Scholar
  18. 18.
    Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America. J Am Med Assoc. 2006; 296(6): 679-690.CrossRefGoogle Scholar
  19. 19.
    Walkup J, Wei W, Sambamoorthi U, Crystal S. Antidepressant treatment and adherence to combination antiretroviral therapy among patients with AIDS and diagnosed depression. Psychiatr Q. 2008; 79(1): 43-53.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Akincigil A, Wilson IB, Walkup JT, Siegel MJ, Huang C, Crystal S. Antidepressant treatment and adherence to antiretroviral medications among privately insured persons with HIV/AIDS. AIDS Behav. 2011; 15(8): 1819-1828.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Yun LW, Maravi M, Kobayashi JS, Barton PL, Davidson AJ. Antidepressant treatment improves adherence to antiretroviral therapy among depressed HIV-infected patients. J Acquir Immune Defic Syndr. 2005; 38(4): 432-438.PubMedCrossRefGoogle Scholar
  22. 22.
    Carrico AW, Antoni MH, Durán RE, et al. Reductions in depressed mood and denial coping during cognitive behavioral stress management with HIV-positive gay men treated with HAART. Ann Behav Med. 2006; 31(2): 155-164.PubMedCrossRefGoogle Scholar
  23. 23.
    Pyne JM, Fortney JC, Curran GM, et al. Effectiveness of collaborative care for depression in human immunodeficiency virus clinics. Arch Intern Med. 2011; 171(1): 23-31.PubMedGoogle Scholar
  24. 24.
    Duncan LG, Moskowitz JT, Neilands TB, Dilworth SE, Hecht FM, Johnson MO. Mindfulness-based stress reduction for HIV treatment side effects: A randomized, wait-list controlled trial. J Pain Symptom Manage. 2012; 43(2): 161-171.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Johnson MO, Dilworth SE, Taylor JM, Neilands TB. Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV. Ann Behav Med. 2011; 41(1): 83-91.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Simoni JM, Huh D, Frick PA, et al. Peer support and pager messaging to promote antiretroviral modifying therapy in Seattle: A randomized controlled trial. J Acquir Immune Defic Syndr. 2009; 52(4): 465-473.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Bottonari KA, Tripathi SP, Fortney JC, et al. Correlates of antiretroviral and antidepressant adherence among depressed HIV-infected patients. AIDS Patient Care STDS. 2012; 26(5): 265-273.PubMedCrossRefGoogle Scholar
  28. 28.
    Rotheram-Borus MJ, Swendeman D, Comulada WS, Weiss RE, Lee M, Lightfoot M. Prevention for substance-using HIV-positive young people: Telephone and in-person delivery. J Acquir Immune Defic Syndr. 2004; 37(Suppl 2): S68-S77.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Cruess DG, Kalichman SC, Amaral C, Swetzes C, Cherry C, Kalichman MO. Benefits of adherence to psychotropic medications on depressive symptoms and antiretroviral medication adherence among men and women living with HIV/AIDS. Ann Behav Med. 2012; 43(2): 189-197.PubMedCrossRefGoogle Scholar
  30. 30.
    Safren SA, O'Cleirigh C, Tan JY, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol. 2009; 28(1): 1-10.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Rosenthal R, Rosnow R. Essentials of behavioral research: Methods and data analysis. 3rd ed. New York: McGraw-Hill; 2008.Google Scholar
  32. 32.
    Chinn S. A simple method for converting an odds ratio to effect size for use in meta-analysis. Stat Med. 2000; 19(22): 3127-3131.PubMedCrossRefGoogle Scholar
  33. 33.
    Rosenthal R, DiMatteo MR. Meta-analysis: Recent developments in quantitative methods for literature reviews. Annu Rev Psychol. 2001; 52(1): 59-82.PubMedCrossRefGoogle Scholar
  34. 34.
    Rosenthal R. Writing meta-analytic reviews. Psychol Bull. 1995; 118(2): 183-192.CrossRefGoogle Scholar
  35. 35.
    Mosteller F, Bush R. Selected Quantitative Techniques. In: Lindzey G, ed. Handbook of Social Psychology. I. Cambridge: Addison-Wesley; 1954.Google Scholar
  36. 36.
    Rosenthal R. The file drawer problem and tolerance for null results. Psychol Bull. 1979; 86(3): 638-641.CrossRefGoogle Scholar
  37. 37.
    Cochran WG. The combination of estimates from different experiments. Biometrics. 1954; 10(1): 101-129.CrossRefGoogle Scholar
  38. 38.
    Rosenthal R. Meta-analytic procedures for social research. Newbury Park, CA: Sage; 1991.Google Scholar
  39. 39.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ Br Med J. 2003; 327(7414): 557-560.CrossRefGoogle Scholar
  40. 40.
    Feaster DJ, Brincks AM, Mitrani VB, Prado G, Schwartz SJ, Szapocznik J. The efficacy of Structural Ecosystems Therapy for HIV medication adherence with African American women. J Fam Psychol. 2010; 24(1): 51-59.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Berger S, Schad T, von Wyl V, et al. Effects of cognitive behavioral stress management on HIV-1 RNA, CD4 cell counts and psychosocial parameters of HIV-infected persons. AIDS. 2008; 22(6): 767-775.PubMedCrossRefGoogle Scholar
  42. 42.
    Safren SA, O'Cleirigh CM, Bullis JR, Otto MW, Stein MD, Pollack MH. Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: A randomized controlled trial. J Consult Clin Psychol. 2012; 80(3): 404-415.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Weber R, Christen L, Christen S, et al. Effect of individual cognitive behaviour intervention on adherence to antiretroviral therapy: Prospective randomized trial. Antivir Ther. 2004; 9(1): 85-95.PubMedGoogle Scholar
  44. 44.
    Mellins CA, Havens JF, McDonnell C, et al. Adherence to antiretroviral medications and medical care in HIV-infected adults diagnosed with mental and substance abuse disorders. AIDS Care. 2009; 21(2): 168-177.PubMedCrossRefGoogle Scholar
  45. 45.
    Horberg MA, Silverberg MJ, Hurley LB, 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): 384-390.PubMedCrossRefGoogle Scholar
  46. 46.
    Steering Committee of the Physicians' Health Study Research Group. Final report on the aspirin component of the ongoing Physicians' Health Study. N Engl J Med. 1989; 321: 129-135.CrossRefGoogle Scholar
  47. 47.
    DiMatteo MR, Haskard KB, Williams SL. Health beliefs, disease severity, and patient adherence: A meta-analysis. Med Care. 2007; 45(6): 521-528.PubMedCrossRefGoogle Scholar
  48. 48.
    Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. J Acquir Immune Defic Syndr. 2006; 43(Suppl 1): S23-S35.PubMedCrossRefGoogle Scholar
  49. 49.
    Amico KR, Harman JJ, Johnson BT. Efficacy of antiretroviral therapy adherence interventions: A research synthesis of trials, 1996 to 2004. J Acquir Immune Defic Syndr. 2006; 41(3): 285-297.PubMedCrossRefGoogle Scholar
  50. 50.
    Schuster R, Bornovalova M, Hunt E. The influence of depression on the progression of HIV: Direct and indirect effects. Behav Modif. 2012; 36(2): 123-145.PubMedCrossRefGoogle Scholar
  51. 51.
    Carrico AW, Antoni MH. Effects of psychological interventions on neuroendocrine hormone regulation and immune status in HIV-positive persons: A review of randomized controlled trials. Psychosom Med. 2008; 70(5): 575-584.PubMedCentralPubMedCrossRefGoogle Scholar
  52. 52.
    Dalessandro M, Conti CM, Gambi F, et al. Antidepressant therapy can improve adherence to antiretroviral regimens among HIV-infected and depressed patients. J Clin Psychopharmacol. 2007; 27(1): 58-61.PubMedCrossRefGoogle Scholar
  53. 53.
    Kong MC, Nahata MC, Lacombe VA, Seiber EE, Balkrishnan R. Association between race, depression, and antiretroviral therapy adherence in a low-income population with HIV infection. J Gen Intern Med. 2012; 27(9): 1159-1164.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Kumar V, Encinosa W. Effects of antidepressant treatment on antiretroviral regimen adherence among depressed HIV-infected patients. Psychiatr Q. 2009; 80(3): 131-141.PubMedCrossRefGoogle Scholar
  55. 55.
    Tsai A, Weiser S, Petersen M, Ragland K, Kuschel M, Bangsberg D. A marginal structural model to estimate the causal effect of antidepressant medication treatment on viral suppression among homeless and marginally housed persons with HIV. Arch Gen Psychiatry. 2010; 67(12): 1282-1290.PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.
    Turner BJ, Laine C, Cosler L, Hauck WW. Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users. J Gen Intern Med. 2003; 18(4): 248-257.PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.
    Winiarski MG, Beckett E, Salcedo J. Outcomes of an inner-city HIV mental health programme integrated with primary care and emphasizing cultural responsiveness. AIDS Care. 2005; 17(6): 747-756.PubMedCrossRefGoogle Scholar
  58. 58.
    Johnson MO, Charlebois E, Morin SF, Remien RH, Chesney MA. Effects of a behavioral intervention on antiretroviral medication adherence among people living with HIV: The healthy living project randomized controlled study. J Acquir Immune Defic Syndr. 2007; 46(5): 574-580.PubMedCentralPubMedCrossRefGoogle Scholar
  59. 59.
    Mann T. Effects of future writing and optimism on health behaviors in HIV-infected women. Ann Behav Med. 2001; 23(1): 26-33.PubMedCrossRefGoogle Scholar
  60. 60.
    Nightingale VR, Sher TG, Thilges S, Niel K, Rolfsen N, Hansen NB. Non-conventional practices and immune functioning among individuals receiving conventional care for HIV. J Health Psychol. 2011; 16(8): 1241-1250.PubMedCentralPubMedCrossRefGoogle Scholar
  61. 61.
    Simoni JM, Pantalone DW, Plummer MD, Huang B. A randomized controlled trial of a peer support intervention targeting antiretroviral medication adherence and depressive symptomatology in HIV-positive men and women. Health Psychol. 2007; 26(4): 488-495.PubMedCrossRefGoogle Scholar
  62. 62.
    Webel AR. Testing a peer-based symptom management intervention for women living with HIV/AIDS. AIDS Care. 2010; 22(9): 1029-1040.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2013

Authors and Affiliations

  1. 1.Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of PsychologyUniversity of CaliforniaRiversideUSA
  3. 3.Center for Healthy AgingThe Pennsylvania State UniversityUniversity ParkUSA

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