Journal of NeuroVirology

, Volume 22, Issue 1, pp 56–65 | Cite as

The role of depression chronicity and recurrence on neurocognitive dysfunctions in HIV-infected adults

  • Lucette A. Cysique
  • Nadene Dermody
  • Andrew Carr
  • Bruce J. Brew
  • Maree Teesson


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.


Major 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.

Supplementary material

13365_2015_368_MOESM1_ESM.pdf (335 kb)
ESM 1 (PDF 334 kb)
13365_2015_368_MOESM2_ESM.pdf (94 kb)
ESM 2 (PDF 94.2 kb)


  1. Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, Clifford DB, Cinque P, Epstein LG, Goodkin K, Gisslen M, Grant I, Heaton RK, Joseph J, Marder K, Marra CM, McArthur JC, Nunn M, Price RW, Pulliam L, Robertson KR, Sacktor N, Valcour V, Wojna VE (2007) Updated research nosology for HIV-associated neurocognitive disorders. Neurology 69:1789–1799PubMedPubMedCentralCrossRefGoogle Scholar
  2. Atkinson JH, Heaton RK, Patterson TL, Wolfson T, Deutsch R, Brown SJ, Summers J, Sciolla A, Gutierrez R, Ellis RJ, Abramson I, Hesselink JR, McCutchan JA, Grant I (2008) Two-year prospective study of major depressive disorder in HIV-infected men. J Affect Disord 108:225–234PubMedPubMedCentralCrossRefGoogle Scholar
  3. Australian Bureau of Statistics (2007) National survey of mental health and wellbeing: summary of results, 2007. Accessed July 2014. ABS, (ed). ABS Cat. No. 4326.0.: Canberra: ABS, 2007
  4. Beck AT, Steer RA, Ball R, Ranieri W (1996a) Comparison of beck depression inventories -IA and -II in psychiatric outpatients. J Pers Assess 67:588–597PubMedCrossRefGoogle Scholar
  5. Beck AT, Steer RA, Brown GK (1996b) Manual for the beck depression inventory-II. Psychological Corporation, San AntonioGoogle Scholar
  6. Carter SL, Rourke SB, Murji S, Shore D, Rourke BP (2003) Cognitive complaints, depression, medical symptoms, and their association with neuropsychological functioning in HIV infection: a structural equation model analysis. Neuropsychology 17:410–419PubMedCrossRefGoogle Scholar
  7. Chelune G, Heaton R, Lehman R (1986) Neuropsychological and personality correlates of patient’s complaints of disability. In: Tarter R, Goldstein G (eds) Advances in clinical neuropsychology. Plenum Press, New York, pp 95–126CrossRefGoogle Scholar
  8. Ciesla JA, Roberts JE (2001) Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry 158:725–730PubMedCrossRefGoogle Scholar
  9. Cysique LA, Deutsch R, Atkinson JH, Young C, Marcotte TD, Dawson L, Grant I, Heaton RK (2007) Incident major depression does not affect neuropsychological functioning in HIV-infected men. J Int Neuropsychol Soc 13:1–11PubMedCrossRefGoogle Scholar
  10. Cysique LA, Franklin D Jr, Abramson I, Ellis RJ, Letendre S, Collier A, Clifford D, Gelman B, McArthur J, Morgello S, Simpson D, McCutchan JA, Grant I, Heaton RK (2011) Normative data and validation of a regression based summary score for assessing meaningful neuropsychological change. J Clin Exp Neuropsychol 33:505–522PubMedPubMedCentralCrossRefGoogle Scholar
  11. Cysique LA, Bain MP, Lane TA, Brew BJ (2012) Management issues in HIV-associated neurocognitive disorders. Neurobehav HIV Med 4:63–73CrossRefGoogle Scholar
  12. Cysique LA, Heaton RK, Kamminga J, Lane T, Gates TM, Moore DM, Hubner E, Carr A, Brew BJ (2014) HIV-associated neurocognitive disorder in Australia: a case of a high-functioning and optimally treated cohort and implications for international neuroHIV research. J Neurovirol 20:258–268PubMedPubMedCentralCrossRefGoogle Scholar
  13. Daughters SB, Braun AR, Sargeant MN, Reynolds EK, Hopko DR, Blanco C, Lejuez CW (2008) Effectiveness of a brief behavioral treatment for inner-city illicit drug users with elevated depressive symptoms: the life enhancement treatment for substance use (LETS Act!). J Clin Psychiatry 69:122–129PubMedCrossRefGoogle Scholar
  14. Dermody N, Batchelor J, Heaton RK, Cysique LA (2014). Cross-cultural validity of U.S. longitudinal normative standards in Australians: preliminary results. In: College of Clinical Neuropsychologists (APS), Adelaide, AustraliaGoogle Scholar
  15. Fellows RP, Byrd DA, Morgello S (2013) Major depressive disorder, cognitive symptoms, and neuropsychological performance among ethnically diverse HIV+ men and women. J Int Neuropsychol Soc 19:216–225PubMedPubMedCentralCrossRefGoogle Scholar
  16. Gibbie T, Mijch A, Ellen S, Hoy J, Hutchison C, Wright E, Chua P, Judd F (2006) Depression and neurocognitive performance in individuals with HIV/AIDS: 2-year follow-up. HIV Med 7:112–121PubMedCrossRefGoogle Scholar
  17. Gold JA, Grill M, Peterson J, Pilcher C, Lee E, Hecht FM, Fuchs D, Yiannoutsos CT, Price RW, Robertson K, Spudich S (2014). Longitudinal characterization of depression and mood states beginning in primary HIV infection. AIDS Behav. 18(6):1124–1132
  18. Grant I, Heaton RK (2014) Neurocognitive change in the era of combination antoretroviral therapy: a longitudinal CHARTER study. In: AIDS 2014. Melbourne, AustraliaGoogle Scholar
  19. Grant I, Franklin DJ, Deutsch R, Woods SP, Vaida F, Ellis RJ, Letendre SL, Marcotte TD, Atkinson JH, Collier AC, Marra CM, CLifford DB, Gelman BB, McArthur JC, Morgello S, Simpson DM, McCutchan JA, Abramson I, HGamst A, Fennema-Notstine C, Smith DM, Heaton RK, Group C (2014) Asymptomatic HIV-associated neurocognitive impairment increases risk for symptomatic decline. Neurology 10: 2055–2062Google Scholar
  20. Gudayol-Ferre E, Guardia-Olmos J, Pero-Cebollero M, Herrera-Guzman I, Camarena B, Cortes-Penagos C, Herrera-Abarca JE, Martinez-Medina P (2013) Prediction of the time-course pattern of remission in depression by using clinical, neuropsychological, and genetic variables. J Affect Disord 150:1082–1090PubMedCrossRefGoogle Scholar
  21. Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H, McCutchan JA, Reicks C, Grant I (2004) The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc 10:317–331PubMedCrossRefGoogle Scholar
  22. Judd LL, Paulus MJ, Schettler PJ, Akiskal HS, Endicott J, Leon AC, Maser JD, Mueller T, Solomon DA, Keller MB (2000) Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? Am J Psychiatry 157:1501–1504PubMedCrossRefGoogle Scholar
  23. Judd F, Komiti A, Chua P, Mijch A, Hoy J, Grech P, Street A, Lloyd J, Williams B (2005) Nature of depression in patients with HIV/AIDS. Aust N Z J Psychiatry 39:826–832PubMedCrossRefGoogle Scholar
  24. Keller MB (2004) Remission versus response: the new gold standard of antidepressant care. J Clin Psychiatry 65(Suppl 4):53–59PubMedGoogle Scholar
  25. Lane TA, Moore DM, Batchelor J, Brew BJ, Cysique LA (2012) Facial emotional processing in HIV infection: relation to neurocognitive and neuropsychiatric status. Neuropsychology 26:713–722PubMedCrossRefGoogle Scholar
  26. Lee RS, Hermens DF, Porter MA, Redoblado-Hodge MA (2012) A meta-analysis of cognitive deficits in first-episode Major Depressive Disorder. J Affect Disord 140:113–124PubMedCrossRefGoogle Scholar
  27. Lejuez CW, Hopko DR, Acierno R, Daughters SB, Pagoto SL (2011) Ten year revision of the brief behavioral activation treatment for depression: revised treatment manual. Behav Modif 35:111–161PubMedCrossRefGoogle Scholar
  28. Mao L, Newman CE, Kidd MR, Saltman DC, Rogers GD, Kippax SC (2009) Self-reported sexual difficulties and their association with depression and other factors among gay men attending high HIV-caseload general practices in Australia. J Sex Med 6:1378–1385PubMedCrossRefGoogle Scholar
  29. Primeau MM, Avellaneda V, Musselman D, St Jean G, Illa L (2013) Treatment of depression in individuals living with HIV/AIDS. Psychosomatics 54:336–344PubMedCrossRefGoogle Scholar
  30. Rabkin JG (2008) HIV and depression: 2008 review and update. Curr HIV/AIDS Rep 5:163–171PubMedCrossRefGoogle Scholar
  31. Relf MV, Eisbach S, Okine KN, Ward T (2013) Evidence-based clinical practice guidelines for managing depression in persons living with HIV. J Assoc Nurses AIDS Care 24:S15–S28PubMedCrossRefGoogle Scholar
  32. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33, quiz 34–57 PubMedGoogle Scholar
  33. Spies G, Asmal L, Seedat S (2013) Cognitive-behavioural interventions for mood and anxiety disorders in HIV: a systematic review. J Affect Disord 150:171–180PubMedCrossRefGoogle Scholar
  34. Thames AD, Becker BW, Marcotte TD, Hines LJ, Foley JM, Ramezani A, Singer EJ, Castellon SA, Heaton RK, Hinkin CH (2011) Depression, cognition, and self-appraisal of functional abilities in HIV: an examination of subjective appraisal versus objective performance. Clin Neuropsychol 25:224–243PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Journal of NeuroVirology, Inc. 2015

Authors and Affiliations

  • Lucette A. Cysique
    • 1
    • 2
    • 3
    • 4
    • 6
  • Nadene Dermody
    • 4
    • 5
  • Andrew Carr
    • 1
    • 3
    • 4
    • 6
  • Bruce J. Brew
    • 1
    • 3
    • 4
    • 6
  • Maree Teesson
    • 6
  1. 1.University of New South WalesSydneyAustralia
  2. 2.Neuroscience Research AustraliaRandwickAustralia
  3. 3.Department of NeurologySt. Vincent’s HospitalSydneyAustralia
  4. 4.St. Vincent’s Hospital Centre for Applied Medical ResearchSydneyAustralia
  5. 5.Department of PsychologyMacquarie UniversitySydneyAustralia
  6. 6.Infectious Diseases DepartmentSt. Vincent’s HospitalSydneyAustralia

Personalised recommendations