ART initiation improves long-term depression symptoms in acute HIV

Improvements in depression symptoms remain stable at 6 years in individuals who maintain viral suppression after antiretroviral therapy (ART) during acute HIV-1 infection (AHI), according to a Thai study presented at the virtual Conference on Retroviruses and Opportunistic Infections (CROI) 2021.

While the 9-item Patient Health Questionnaire (PHQ-9) score at 6 years is associated with baseline score during AHI, moderate-to-severe depression symptoms during AHI “do not portend durable depression symptoms or impaired immunologic recovery after long-term ART,” the researchers said.

A total of 254 cohort participants initiated ART at a median 0 days (interquartile range [IQR], 0.1) following AHI diagnosis (Fiebig I-V) and completed the PHQ-9 (score 0–27) for depression symptoms and the Distress Thermometer (DT) for anxiety/stress (score 0–10) at untreated AHI (baseline), weeks 12, 24, 96, and every 48 weeks thereafter.

In the analysis, the researchers included participants who maintained suppressive ART over 288 weeks of follow-up, defined by the absence of plasma HIV RNA >400 cps/ml. Then, they compared week 288 PHQ-9 scores, CD4+ T cell counts, and CD4/CD8 levels based on baseline PHQ-9 scores (no depression: ≤9; moderate depression: 10-14; moderate-to-severe depression: ≥15).

Of the participants, 243 reached week 288 post-ART. Fifteen individuals withdrew from the cohort; 17 did not meet the HIV control criteria; 54 were co-enrolled into analytical treatment interruption studies; and 30 did not have paired baseline and week 288 records. Only 127 participants remained (median age, 28 years; 95 percent male), with median PHQ-9 and DT scores at baseline of 9 (IQR, 7–16) and 6 (IQR, 3.2–7.5), respectively. [CROI 2021, abstract 340]

At baseline, the rates of moderate and moderate-to-severe depression symptoms were 21 percent and 27 percent, respectively. Median PHQ-9 and DT scores both improved post-ART to subclinical levels by week 24. After week 96, the corresponding rates of moderate and moderate-to-severe depression symptoms remained stable at about 10 percent and ≤4 percent.

An association was observed between baseline PHQ-9 score and the score at week 288 (p<0.001). Individuals with PHQ-9 ≥15 at baseline had higher plasma HIV RNA (p=0.011) and frequency of acute retroviral syndrome (p=0.043) as compared to the rest of the participants (PHQ-9 <15).

Individuals with PHQ-9 ≥15 at baseline also tended to have higher PHQ-9 scores than those in the no depression group at week 288 (5 [IQR, 2–8] vs 4 [IQR, 1–6]; p=0.083). However, the former showed a noninferior immune recovery in CD4+ T-cell and CD4/CD8 levels.

“In those who maintain viral suppression after ART initiation during AHI, depression symptoms remain stably improved at 6 years,” the researchers said.

An earlier study in Uganda and Kenya found that depression was not a barrier to ART initiation among East African HIV-infected persons in HIV serodiscordant couples. Additionally, ART initiation resulted in improved depressive symptoms in this setting. [AIDS Behav 2017;21:2509-2518]