AIDS: treating depression improve compliance vis-à-vis the antiretroviral treatment

Most depression and treated with antidepressants HIV patients are more adherent vis-à-vis their antiretroviral treatment HIV + patients untreated depression shows a retrospective American study published in the "Journal of the AIDS."

Poor adherence to antiretroviral treatment reduces its effectiveness, but can also lead to its final inefficiency by encouraging the emergence of resistant mutations, say the authors, Dr. Lourdes Yun and colleagues at the Public Health Service in Denver.

Depression, a higher prevalence in HIV + patients compared with the general population, was associated with lower adherence to treatment of chronic diseases. That is why these American researchers conducted a retrospective study to analyze the impact of depression on adherence to HIV + patients.

They analyzed data collected between January 1997 and December 2001 among 1,700 HIV + for over 12 years patients. Half (52%) followed antiretroviral therapy.

The rate of adherence to antiretroviral therapy was 72%, with 26% achieving an optimal adherence rates (above 95%).

The prevalence of depression was high, affecting more than half (57%) patients. Antidepressants were prescribed to 46% of them.

The proportion of depressed patients with good adherence to antiretroviral therapy was significantly lower among patients without prescription antidepressants compared to those treated (35% against 65%).

Moreover, this increased compliance within six months of the initiation of antidepressant treatment, patients correctly or not following the prescription of antidepressants.

Finally, the proportion of depressed patients observing their antiretroviral treatment was even higher among patients observing their antidepressant treatment among those who followed their bad treatment (69% against 31%).

"While this suggests a positive effect of antidepressant treatment on adherence to antiretroviral treatment, it may also reflect intrinsic behavior observing the patient, and vis-à-vis any treatment," the authors admit, nevertheless recommending "routine search of depression, particularly in HIV + patients not adherent vis-à-vis their antiretroviral treatment."

"The diagnosis of depression can be difficult in HIV + patients," say they, "should strengthen the education of health personnel, including antidepressants inform effective treatments available and the need to initiate early treatment."

Prospective studies are also needed to confirm the correlation between adherence to antidepressant treatment and clinical improvement in depression, and the effect of this improvement on adherence to antiretroviral treatments, they say.