Perinatal depression in women with HIV interferes with viral suppression

Pregnant women who exhibit depressive symptoms are highly likely to have decreased adherence to antiretroviral therapy (ART), which in turn negatively affects viral suppression, a study reports.

A total of 1,869 women participated in the study, among whom 47.6 percent were aged 21–29 years and 57.6 percent were non-Hispanic Black. All of them completed the AIDS Clinical Trials Group (ACTG) Quality of Life questionnaire to assess perinatal depressive symptoms (possible total score of 6–36, with higher scores indicating more symptoms).

In the third trimester of pregnancy, the mean depressive symptoms score was 14.0. Most of the women (68.0 percent) showed consistent adherence to treatment (no missed dose in the past 1-4 weeks using the ACTG Adherence Questionnaire), and 77.3 percent achieved viral suppression (viral load <400 copies/mL).

Depressive symptoms decreased at 6 months postpartum, whereas adherence and viral suppression dropped to 59.8 percent and 53.0 percent, respectively.

In the fully-adjusted generalized mixed-effects structural equation model, each 1-standard deviation increase in depressive symptoms correlated with a 3.8-percentage-point (95 percent confidence interval [Cl], –5.7 to –1.9) decline in viral suppression.

The above association was found to be the sum of the indirect effect of depressive symptoms on viral suppression via ART adherence (–0.4, 95 percent CI, –0.7 to –0.2) and the direct effect through other pathways (–3.4, 95 percent CI, –5.2 to –1.5).

The drop in treatment adherence attributed to depressive symptoms accounted for ≥11 percent of the total negative effect of depressive symptoms on viral suppression.

The findings underscore the need to screen for, diagnose, and treat perinatal depression to improve maternal outcomes.