Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women - Longitudinal analysis from the HIV epidemiology research study

Context The impact of depression on morbidity and mortality among women wit h human immunodeficiency virus (HIV) has not been examined despite the fact that women with HIV have substantially higher rates of depression than the ir male counterparts. Objective To determine the association of depressive symptoms with HIV-rela ted mortality and decline in CD4 lymphocyte counts among women with HIV. Design The HIV Epidemiologic Research Study, a prospective, longitudinal co hort study conducted from April 1993 through January 1995, with follow-up t hrough March 2000. Setting Four academic medical centers in Baltimore, Md; Bronx, NY; Providen ce, RI; and Detroit, Mich. Participants A total of 765 HIV-seropositive women aged 16 to 55 years. Main Outcome Measures HIV-related mortality and CD4 cell count slope declin e over a maximum of 7 years, compared among women with limited or no depres sive symptoms, intermittent depressive symptoms, or chronic depressive symp toms, as measured using the self-report Center for Epidemiologic Studies De pression Scale. Results In multivariate analyses controlling for clinical, treatment, and o ther factors, women with chronic depressive symptoms were 2 times more like ly to die than women with limited or no depressive symptoms (relative risk [RR], 2.0; 95% confidence interval [CI], 1.0-3,8). Among women with CD4 cel l counts of less than 200 x 10(6)/L, HIV-related mortality rates were 54% f or those with chronic depressive symptoms (RR, 4.3; 95 % CI, 1.6-11.6) and 48% for those with intermittent depressive symptoms (RR, 3.5; 95% CI, 1.1-1 0.5) compared with 21% for those with limited or no depressive symptoms. Ch ronic depressive symptoms were also associated with significantly greater d ecline in CD4 cell counts after controlling for other variables in the mode l, especially among women with baseline CD4 cell counts of less than 500 x 10(6)/L and baseline viral load greater than 10000 copies/mul. Conclusions Our results indicate that depressive symptoms among women with HIV are associated with HIV disease progression, controlling for clinical, substance use, and sociodemographic characteristics. These results highligh t the importance of adequate diagnosis and treatment of depression among wo men with HIV, Further research is needed to determine if treatment of depre ssion can not only enhance the mental health of women with HIV but also imp ede disease progression and mortality.