AEGiS-15IAC: Impact of depression on all cause mortality among men and women initiating HAART.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Impact of depression on all cause mortality among men and women initiating HAART.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrD1087)

Hogg RS, Bonner SJ, Daniel M, Harrigan PR, Yip B, Braitstein P, Wood E, Montaner JS
BC Centre for Excellence in HIV/AIDS, Vancouver, Canada

BACKGROUND: The impact of depression and its symptomatology on mortality has not been widely examined in persons first accessing HAART. The objective of this study was to determine the impact of depression on survival in antiretroviral naïve persons accessing HAART.

METHODS: Our study is based upon HIV-positive individuals aged 18 years and older who initiated HAART in BC between August 1, 1996 and June 30, 2002 and completed a baseline participant survey within the first year. The participant survey elicited information on sociodemographic characteristics, depression, clinical and health status, and alternative therapy use. Self-reported levels of depression were obtained from the CES-D scale. The primary endpoint was time to all cause mortality. Cox-proportional hazard regression was used to model the simultaneous effect of prognostic variables on all cause mortality after the initiation of therapy.

RESULTS: Our study consisted of 563 men and women, of whom 54 (9.6%) had died after initiating HAART. In univariable analysis, higher baseline CES-D score was associated with shorter time to death (Hazard Ratio [HR] =1.23 per 10 point increase, 95% CI: 1.02, 1.48). Further analysis revealed that the somatic and retarded activity (bothered, appetite, effort, sleep, get going) sub-scale was strongly associated with the time to death (HR =1.07, 95% CI: 1.02, 1.12) and the positive affect (good, hopeful, happy, enjoy) sub-scale was marginally associated (HR =1.09, 95% CI: 1.01, 1.17). In multivariable models, only the somatic and retarded activity sub-scale remained as a significant predictor of the time to death (Adjusted HR =1.05, 95% CI: 1.00,1.10), along with adherence (AHR=4.89, 95% CI: 2.80,8.51), age (AHR =1.20 per 10 year increase, 95% CI: 1.03,1.39), and baseline CD4 cell count (AHR =1.05 per 100 cell decrement, 95% CI: 1.02,1.08). Conclusion Our data support the hypothesis that depression is a prognostic factor associated with shorter survival. These findings suggest the importance of treating depression among persons on HAART.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Depression, Depressive Disorder, CD4 Lymphocyte Count, Cause of Death, HIV Seropositivity, Disease Progression, Treatment Outcome, Humans, Female, Male, mortality, etiology

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MoOrD1087