Poor CD4 Count Is a Predictor of Untreated Depression in HIV-Positive African-Americans

AIM:

To determine if efforts to improve antiretroviral therapy (ART) adherence minimizes the negative impact of depression on human immunodeficiency virus (HIV) outcomes.

METHODS:

A cross-sectional study of a clinic-based cohort of 158 HIV seropositive (HIV+) African Americans screened for major depressive disorder (MDD) in 2012. CD4 T lymphocyte (CD4+) counts were obtained from these individuals. Self-report on adherence to ART was determined from questionnaire administered during clinic visits. The primary outcome measure was conditional odds of having a poorer CD4+ count (< 350 cells/mm(3)). Association between CD4+ count and antidepressant-treated or untreated MDD subjects was examined controlling for self-reported adherence and other potential confounders.

RESULTS:

Out of 147 individuals with available CD4+ T lymphocyte data, 31% hadCD4+ count < 350 cells/mm(3) and 28% reported poor ART adherence. As expected the group with > 350 cells/mm(3) CD4+ T lymphocyte endorsed significantly greater ART adherence compared to the group with < 350 cells/mm(3) CD4+ T lymphocyte count (P < 0.004). Prevalence of MDD was 39.5% and 66% of individuals with MDD took antidepressants. Poor CD4+ T lymphocyte count was associated with poor ART adherence and MDD. Adjusting for ART adherence, age, sex and education, which were potential confounders, the association between MDD and poor CD4+ T lymphocyte remained significant only in the untreated MDD group.

CONCLUSION:

Therefore, CD4+ count could be a clinical marker of untreated depression in HIV+. Also, mental health care may be relevant to primary care of HIV+ patients

Demographic and behavioral characteristics of study participants with or without depression

Characteristics	No MDD	MDD treated	MDD untreated	P
	(n = 89)	(n = 38)	(n = 20)
	(%)	(%)	(%)
Gender
Male	63.27	50	60	0.35
Female	36.73	50	40
Age groups
> 55	24.49	5	15	0.12
35-55	62.24	77.5	70
< 35	13.27	17.5	15
Monthly income
0-200	32.61	30.77	33.33	0.32
204-670	17.39	25.64	5.56
672-739	21.74	30.77	27.78
743-2650	28.26	12.82	33.33
Educational status
No college	70.59	78.57	72.73	0.73
College	29.41	21.43	27.27
Accommodation
Yes	60.42	72.50	70	0.35
No	39.58	27.50	30
HIV treatment adherence
No	26.53	25	45	0.51
Yes	48.98	52.50	40
Unknown	24.49	22.50	15
Substance abuse
No	41.84	30	45	0.37
Yes	58.16	70	55
Problem drinking
No	72.45	53.85	45	0.02
Yes	27.55	46.15	55

HIV: Human immunodeficiency virus; MDD: Major depressive disorder.

Full article at:   http://goo.gl/7ob6Eo

By:  Amanor-Boadu S1, Hipolito MS1, Rai N1, McLean CK1, Flanagan K1, Hamilton FT1, Oji V1, Lambert SF1, Le HN1, Kapetanovic S1, Nwulia EA1.

1Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States

World J Psychiatry. 2016 Mar 22;6(1):128-35. doi: 10.5498/wjp.v6.i1.128. eCollection 2016.

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