DEPRESSIVE AFFECT AND SURVIVAL AMONG GAY AND BISEXUAL MEN INFECTED WITH HIV

Background: Although depression has been related to chronic disease pr ocesses and outcomes, studies examining the relationship between depre ssion and disease progression in persons with human immunodeficiency v irus (HIV) infection have produced inconsistent results. Objective: To investigate whether depressive affect is associated with HIV mortalit y. Methods: This was a prospective cohort study (San Francisco Men's H ealth Study) using a population-based probability sample of single men living in areas of San Francisco, Calif, with high case rates of acqu ired immunodeficiency syndrome. Data collection was at 6-month interva ls with up to 15 waves of follow-up. Subjects included all 402 homosex ual or bisexual men who in July 1984 had serologic evidence of HIV inf ection and who survived a minimum of 1 wave after baseline. Depressive affect was measured at each wave with the affective subscale of the C enter for Epidemiologic Studies-Depression Scale. Laboratory markers, World Health Organization staging, antiretroviral use, and hospitaliza tions were also used as predictor variables. The primary outcome measu re was survival. Results: In a Cox proportional hazards model, a time- dependent measure of depressive affect was associated with greater mor tality (adjusted risk ratio, 1.67; 95% confidence interval, 1.01-2.78) . Conclusions: Depressive affect was associated with mortality risk, h ighlighting the importance of diagnosis and treatment of depression am ong HIV-infected gay and bisexual men. Replication of this effect in i ncident cohorts with well-characterized dates of HIV infection is need ed and, if replicated, an exploration of mediating pathways suggested.