DEPRESSIVE SYMPTOMS AS PREDICTORS OF MEDICAL OUTCOMES IN HIV-INFECTION

Objective.-To ascertain whether depressive symptoms as determined by t he Center for Epidemiologic Studies-Depression scale (CES-D) predict a ccelerated mortality and worse medical outcomes in patients infected w ith human immunodeficiency virus (HIV). Design.-Eight-year cohort stud y with semiannual follow-up. Setting.-Community volunteers. Participan ts.-A total of 1809 HIV-seropositive homosexual men without the acquir ed immunodeficiency syndrome (AIDS) who entered the Multicenter AIDS C ohort Study in 1984 or 1985. Eight-year follow-up data were available on 75% of eligible participants. Outcome Measures.-Times to AIDS, deat h, and prophylactic treatment, and slopes describing the decline in CD 4 count for each individual participant. Results.-Using a conventional definition of depression (CES-D greater-than-or-equal-to 16 at the fi rst study visit), 21.3% of participants were classified as depressed. Depressed participants had lower CD4 counts and reported more AIDS-rel ated symptoms. There were no significant differences between depressed and nondepressed participants on any of the outcome measures (P>.05 i n all cases). In contrast, men reporting AIDS-related symptoms had sho rter times to AIDS and to death even after adjusting for CD4 counts (P <.01). The analyses were repeated, with similar results, using differe nt definitions of depression based on the CES-D. Conclusions.-We find no evidence that depressive symptoms independently prognosticate worse outcomes in HIV infection. Because of associations of depression with symptom reports, CD4 counts, and indicators of socioeconomic status, future studies of the relationship between depression and HIV outcome should consider these variables as confounders.