Depression is a common co-morbidity for People Living With HIV (PLWH) and is associated with non-adherence to antiretrovirals (ARVs). Psychosocial interventions often focus on ARV adherence. However, depression may be associated with HIV outcomes (e.g., viral load) through other pathways, as well (Figure).
The African Cohort Study (AFRICOS) is prospective longitudinal cohort study at eleven HIV care sites in Kenya, Tanzania, Uganda, and Nigeria. For cultural consistency, we examined East African sites (Kenya, Uganda and Tanzania) (n=2,335). Using baseline data from HIV+ AFRICOS participants, all of whom are engaged in HIV care, we assessed cross-sectional relationships between depression, ARV adherence, HIV viral load and cognition. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale Revised (diagnostic cut-off > 16). Logistic regression was used to model self-report of complete/incomplete ARV adherence over the past month, and linear regression was used to model the log10 of HIV viral load and CESD-items (individually) among participants on ARVs for 6 months or more. Covariates included demographics, purchasing power, cognitive impairment and ARV adherence.
The point prevalence of depression is 18% to 25% among East African HIV+ AFRICOS study participants-all enrolled in HIV care. Depression is associated with decreased ARV adherence (OR 0.39-0.88, p = 0.01) independently of cognitive impairment. Depression is associated with a nearly double the viral load of non-depressed counterparts, independently of ARV adherence and cognitive impairment (proportional increase 1.42-2.34, p= 0.00) for participants on ARVs > 6 months. Seven of the nine depression symptom clusters are significantly associated with viral load independently of ARV adherence and cognition for participants on ARVs > 6 months.
HIV+ East African AFRICOS participants enrolled in HIV care have high prevalence of depression. Depression is associated with viral load independently of pathways involved with ARV adherence or misclassification of cognitive impairment. Depression and HIV viral load is associated across a wide spectrum of depressive symptoms, implying that comprehensive depression treatment is necessary to fully address the relationship between HIV viral load and depression. Future research should include scalable, evidence-based depression treatment for PLWH with assessment of impact on HIV viral load.