Association Between Depression and Antiretroviral Therapy Use Among People Living with HIV: A Meta-analysis
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Depression is common among people living with HIV (PLHIV). Studies on the relationship between depression and use of antiretroviral therapy (ART) are inconclusive. A meta-analysis was conducted to summarize the relationship between depression and ART use among PLHIV. Ten electronic databases, conference abstracts, and dissertations were searched. A random effects meta-analysis was performed to pool the odds ratio estimates from eligible studies. Subgroup analyses and meta-regression were conducted for moderator analysis. Sensitivity analysis was performed to find influential studies. A funnel plot, the Egger test, and the trim and fill analysis were used to detect publication bias. The pooled sample size was 7375 PLHIV from nine eligible studies. The pooled prevalence of depression was 41% (95% confidence interval [CI] 29–53%). The pooled ART use rate was 52% (95% CI 37–67%). PLHIV with depression were 14% less likely (pooled odds ratio [OR] = 0.86; 95% CI 0.71–1.05) to use ART than those without depression. Subgroup analyses showed that depression was significantly associated with no ART use (pooled OR 0.84; 95% CI 0.71–0.99) among studies with a prospective study design (11 estimates from nine studies). Moderator analyses did not show any statistically significant effects. The publication bias analyses showed small study effects may not exist. Depression was associated with non-use of ART among PLHIV. Studies are needed to explore this association in other countries with varied populations, as most published studies have been conducted in the United States.
KeywordsDepression Antiretroviral therapy People living with HIV (PLHIV) Meta-analysis Systematic review
We appreciate that Aaron M. Kipp, Bryan E. Shepherd, Emily E. Tanner-Smith, and K. Rivet Amico provide their valuable comments on this work.
This study was funded by the United States National Institutes of Health under Award Numbers R01AI094562 and R34AI091446.
HQ, JT, and SV initiated this study. JT searched for related literature, information extraction, and analysis. HQ and SV provided valuable suggestions and comments for this manuscript.
Compliance with Ethical Standards
Conflict of interest
Sten Vermund received Grant R01AI094562 and R34AI091446 from the United States National Institutes of Health. He has no conflict of interest. Jun Tao and Han-Zhu Qian declare no conflict of interest.
This study was non-human subject study focusing on review of published literature. It did not involve animals.
Our study did not involve human beings.
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