Depression has a significant impact on adherence to
antiretroviral therapy, according to a meta-analysis published in the online
edition of the Journal of Acquired Immune
The results of 95 studies involving 36,000 patients were
examined by investigators, who comment “depression is consistently associated
with nonadherence to HIV treatment.”
Depression was associated with poorer adherence in
cross-sectional and longitudinal studies, in both resource-rich and
resource-poor settings, and in all populations affected by HIV.
“Interventions that target depressive symptoms and optimal
utilisation of HAART [highly active antiretroviral therapy] may have maximal
effects on health outcomes,” write the authors.
HIV therapy works best if all or nearly all of the
recommended doses are taken correctly. However, many patients have difficulty
adhering to their therapy, and poorer adherence has been associated with an
increased risk of treatment failure.
Missing occasional doses of medication is usually due to
simple forgetfulness and is unlikely to have any clinical significance. However,
poorer adherence can be related to social circumstances or co-morbid
conditions, including mental health problems.
Depression and depressive symptoms are common in patients
with HIV, with some studies finding a prevalence of 36%.
Many studies have looked at the relationship between
depression and poor adherence to HIV therapy, but until now there has been no
meta-analysis of their results, evaluating the strength and consistency of
Therefore a team of investigators lead by Dr Jeffrey
Gonzalez of the Albert Einstein College of Medicine, New York, conducted a
literature search to identify studies published since 1996 that examined the
impact of depression or depressive symptoms on adherence.
A total of 95 studies involving over 36,000 patients met
their inclusion criteria.
Overall, the studies showed a highly significant
relationship between depression and non-adherence (p < 0.0001).
The overall effect of depression on adherence was relatively
modest (0.19). However, the investigators note that it was of a similar
magnitude to that observed in a separate meta-analysis into the effect of
depression on adherence in other chronic illnesses.
Studies that measured adherence by interview found a
significantly stronger relationship between depression and non-adherence that
studies employing self-completed questionnaires (p = 0.03).
Depression was equally likely to affect adherence in
cross-sectional and longitudinal studies.
Even mild symptoms of depression were associated with poorer
adherence, the investigators commenting, “Our findings also suggest that the
relationship between depression and HAART nonadherence is not limited to
comparisons between those who meet the criteria for clinical depression and
those who do not…studies that focused on depression diagnosis found equivalent
effects to studies that measured depression as a degree of symptom severity.”
However, the meta-analysis was not able to show how depression
The researchers speculate that it could be related to its
impact on concentration, appetite, self-worth, or self-care.
They conclude, “novel approaches to the successful
management of these linked problems could have significant public health
benefits for patients living with HIV/AIDS."