SSRI Antidepressants Help Many HIV Patients with Depression Adhere to HAART

By Ronald Baker, PhD

Results of a study described in the December 13, 2007 electronic edition of the Journal of Acquired Immune Deficiency Syndromes (JAIDS) show that HIV positive individuals with clinical depression who take selective serotonin reuptake inhibitors (SSRIs), a class of commonly used antidepressants, are more likely to adhere to their antiretroviral therapy.

Commonly used SSRIs include the following drugs:

citalopram (Celexa, Cipramil, Emocal, Sepram, Seropram)

escitalopram oxalate (Lexapro, Cipralex, Esertia)

fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Fluctin)

fluvoxamine maleate (Luvox, Faverin)

paroxetine (Paxil, Seroxat, Aropax, Deroxat, Rexetin, Xetanor, Paroxat)

sertraline (Zoloft, Lustral, Serlain)

Researchers at two large health maintenance organizations conducted a retrospective cohort study to determine the impact of depression on HAART adherence and clinical measures, and to investigate whether SSRIs could improve these measures.

The investigators examined the effects of depression (with and without SSRI treatment) on adherence and changes in virological and immunological control among HIV patients starting a new HAART regimen. HAART adherence, HIV RNA levels, and changes in CD4 T-cell counts through 12 months were assessed.

Results

• A total of 3359 patients were evaluated; 42% had a depression diagnosis and 15% used SSRIs while on HAART.

• Depression without SSRI treatment was associated with significantly decreased odds of achieving ≥ 90% adherence to HAART (P = 0.03).

• Depression was associated with significantly lower odds of achieving an HIV RNA level < 500 copies/mL (P = 0.02).

• Depressed patients compliant with SSRI medication (> 80% adherence to SSRIs) had HAART adherence and virological control statistically similar to that of non-depressed HIV patients taking HAART.

• Comparing depressed with non-depressed patients, CD4 cell responses were statistically similar.

• Among depressed patients, those compliant with SSRI treatment had significantly greater increases in CD4 cell responses.

Conclusion

Based on these results, the researchers concluded, “Depression significantly worsens HAART adherence and HIV viral control. Compliant SSRI use is associated with improved HIV adherence and laboratory parameters.”

More information

Neurological Complications of AIDS Fact Sheet

Mental Health AIDS Newsletter

HIV Research, Kaiser Permanente, Oakland, CA; HIV Medicine, Kaiser Permanente, Los Angeles, CA; HIV Infectious Disease, Kaiser Permanente, Hayward, CA; Infectious Disease, Kaiser Permanente, Washington, DC; HIV Infectious Disease, Kaiser Permanente, Atlanta, GA; Immune Deficiency Clinic, Kaiser Permanente, Portland, OR; HIV Infectious Disease, Kaiser Permanente, Denver, CO; HIV Medicine, Group Health Cooperative, Seattle, WA; HIV Infectious Disease, Kaiser Permanente, Cleveland, OH; HIV Medicine, Kaiser Permanente, Honolulu, HI.

01/15/08

Reference
MA Horberg, MJ Silverberg, LB Hurley, and others. Effects of Depression and Selective Serotonin Reuptake Inhibitor Use on Adherence to Highly Active Antiretroviral Therapy and on Clinical Outcomes in HIV-Infected Patients. Journal of Acquired Immune Deficiency Syndromes. December 13, 2007 [Epub ahead of print].