Researchers from Boston University's School of Medicine (BUSM) and College of Arts and Sciences (CAS) found that among HIV-infected Russian drinkers, depressive symptom severity alone was not significantly associated with lower rates of antiretroviral therapy (ART) initiation. However, when examining cognitive symptoms of depression, results showed that high levels of depressive symptoms may be associated with delayed ART initiation. The findings are published online in the journal AIDS and Behavior.
While depressive symptoms impact on adherence to ART is widely studied, there are few studies that have investigated the impact of these symptoms on initiating ART. According to the researchers, understanding factors associated with ART initiation may be particularly useful in locations where it is not as commonly prescribed, such as Russia, which has experienced a dramatic increase in HIV infection rates during the past decade.
Led by Jeffrey Samet, MD, chief and professor of internal medicine at BMC and BUSM and principal investigator of the study, the researchers enrolled participants from the HIV's Evolution in Russia -- Mitigating Infection Transmission and Alcoholism in a Growing Epidemic (HERMITAGE) study. The 133 eligible participants had their depressive symptom severity measured at the six- and 12-month marks.
Although the results did not provide evidence that depressive symptom severity alone had a statistically significant effect on ART initiation, findings suggested a potential role of cognitive depressive symptoms in decisions to initiate ART. According to the researchers, cognitive symptoms of depression are often considered to be an index of depression that is less influenced by HIV symptoms. Further, the study demonstrated findings consistent with existing studies that show participants with co-morbid heavy drinking and injection drug use appeared to have delayed ART initiation.
"Depressive symptoms have been shown to influence progression of HIV and have been associated with poor virologic response to treatment and increased immunologic failure," said Tracie Goodness, a doctoral student in clinical psychology at CAS and corresponding author of the study. "Timely ART initiation has been associated with multiple positive health effects, such as lower mortality, increased immune functioning and lower rates of HIV transmission," she added.
Although more research is needed, these results provide initial evidence of the role of depressive symptoms and may contribute to the understanding of ART initiation in HIV-infected populations
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