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Psychiatric Symptoms Are Common in Acute HIV and Correlate With Disease Biomarkers
Joanna M. Hellmuth1; Chun-Zi Peng2; Victor Valcour1; Donn Colby3; Ponpen Tantivayakul3; Shelly Krebs4; Praphan Phanuphak5; Serena S. Spudich6; Robert Paul2; for the RV254/SEARCH 010 Study Group
1Univ of California San Francisco, San Francisco, CA, USA;2Missouri Inst of Mental Hlth, St. Louis, MO, USA;3SEARCH, Bangkok, Thailand;4Military HIV Rsr Prog, Bethesda, MD, USA;5Thai Red Cross AIDS Rsr Cntr, Bangkok, Thailand;6Yale Univ Sch of Med, New Haven, CT, USA
To assess the trajectory of anxiety and depression in acute HIV infection over six months following HIV diagnosis, and assess correlations between affective symptoms and blood and cerebrosinal fluid (CSF) disease biomarkers prior to treatment.
A total of 123 participants were enrolled during acute HIV infection (Fiebig I-V) through the SEARCH010/RV254 cohort in Bangkok, Thailand. Participants completed the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ-9) at baseline prior to combination antiretroviral therapy (cART) and again at weeks 4, 12, and 24 following diagnosis. Depression was defined as a score ≥ 8/21 on HADS-D or ≥10/27 on PHQ-9, with anxiety defined as a score ≥8/21 on HADS-A. Disease biomarkers of plasma and CSF HIV RNA levels, CD4 count, and plasma and CSF neopterin were obtained at entry, as was magnetic resonance spectroscopy (MRS).
At diagnosis, 46% of subjects met the clinical cutoff for depression on the PHQ-9 and 41% on the HADS-D, with 66% meeting the threshold for anxiety on the HADS-A. Affective symptoms decreased from baseline to week 12 without significant change from week 12 to week 24 (8% frequency on HADS-D, 18% frequency on PHQ-9, 17% frequency on HADS-A at the final visit). At baseline, higher average log10 plasma HIV RNA was observed in participants experiencing depression on the HADS-D (5.9 vs. 5.7; p=0.006), or on the PHQ-9 (6.0 vs. 5.6; p=0.010) compared to those not experiencing significant depression. Similarly, those with baseline depression on the PHQ-9 had a lower CD4 count (330 vs. 414 cells/mm3; p=0.024) and higher plasma neopterin, a marker of macrophage activation (3150 vs. 2118 pg/mL; p=0.026). CSF neopterin was higher on average in those experiencing baseline anxiety on the HADS-A (3218 vs. 1545 pg/mL; p=0.011; n=19). Examined as continuous variables, CSF neopterin correlated with PHQ-9 depression scores (r=0.47; p=0.044) and plasma neopterin correlated with HADS-A anxiety scores (r=0.304; p=0.037). No differences between groups were seen on MRS indices.
In acute HIV infection, anxiety and depression are tightly linked to disease biomarkers, including indicators of plasma and intrathecal immune activation. These results confirm high rates of anxiety and depression in acute HIV that decrease with time in the setting of early cART, stabilizing at weeks 12 and 24.