The role of depression chronicity and recurrence on neurocognitive dysfunctions in HIV-infected adults
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Research assessing whether major depressive disorders (MDD) impacts neurocognitive functions in HIV+ persons has yielded inconsistent results. However, none have considered the role of MDD remission, chronicity, and stability on treatment. Ninety-five HIV+ adults clinically stable on combined antiretroviral treatment completed a psychiatric interview, a depression scale, a neuropsychological, daily living, and cognitive complaints assessments at baseline and 18 months. Participants were screened for current (within 12 months of study entry) alcohol and/or substance use disorder. History of alcohol and/or substance abuse disorder prior to the 12 months entry screen and MDD treatments were recorded. Participants were grouped into two psychiatric nomenclatures: (1) lifetime: no MD episode (MDE), single MDE life-event treated and fully remitted, chronic MDD treated and stable, chronic MDD treated and unstable, and baseline untreated MDE; (2) recent: last 2 years MDE (yes or no). We found that lifetime and recent psychiatric history were more strongly associated with decreased in independence in daily living and cognitive complaints than with baseline neuropsychological performance. However, lack of full remission, instability on treatment in chronic MDD, and severity of symptoms in current MDE were factors in whether MDD impacted baseline neuropsychological performance. Depressive symptoms improved at follow-up in those with baseline moderate-severe symptoms, and MDD was not associated with neurocognitive change at 18 months. A history of alcohol and/or substance abuse disorder was significantly more frequent in those with treated and unstable chronic MDD but it was not associated with neuropsychological performance. MDD recurrence, chronicity profiles, and associated comorbidities are keys factors to understand any potential impact on neurocognitive abilities in HIV infection. More comprehensive consideration of these complex effects could serve at constructively updating the HAND diagnostic criteria.
KeywordsMajor depressive disorder Depression HIV AIDS Neuropsychological functions Longitudinal study
We thank the participants for their time on the study. This study was supported by the National Heath and Medical Research Council of Australia project grant ID568746 (Cysique CIA/PI), 2012 Mercks Sharp Dome (MSD) partial salary support for 2012 for Lucette Cysique. MSD had no direct participation in the current study design, data analyses, and interpretation.
Lucette A. Cysique is supported by the National Heath and Medical Research Council of Australia Career Development Fellowship APP1045400 (Cysique CIA/PI). Dr. Cysique has otherwise no conflict of interest with the organizations that funded this research.
Andrew Carr has received grants from the National Health and Medical Research Council of Australia, has received research funding, consultancy fees, lecture and travel sponsorships from MSD, and has served on advisory boards for MSD. Prof. Carr has otherwise no conflict of interest with the organizations that funded this research.
Bruce J. Brew has received grants from the National Health and Medical Research Council of Australia, had received payment as board member for MSD, and received travel/accommodation expenses covered or reimbursed by MSD. Prof. Brew has otherwise no conflict of interest with the organizations that funded this research.
Maree Teeson has received grants from the National Health and Medical Research Council of Australia.
Nadene Dermody reports no conflicts of interest.
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