[NATAP] Depression Reduced HAART Response

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The Association of Race, Sociodemographic, and Behavioral Characteristics With Response to Highly Active Antiretroviral Therapy in Women

…..The poorer responses to HAART found in African American and Latina women, however, were explained largely by HAART discontinuation and to a lesser extent, by depression……This suggests that treating depression and ascertaining and addressing reasons for treatment discontinuation could substantially improve outcomes in African American and Latina women….

JAIDS Journal of Acquired Immune Deficiency Syndromes: Volume 39(5) 15 August 2005 pp 537-544

Anastos, MD*; for the Women's Interagency HIV Study Collaborative Group

From the *Departments of Medicine and Epidemiology and Population Health, Montefiore Medical Center, Bronx, NY;

The WIHS is funded by the National Institute of Allergy and Infectious Diseases, with additional supplemental funding from the National Cancer Institute, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, and the National Institute of Craniofacial and Dental Research (U01-AI-35004, U01-AI-31834, U01-AI-34994, AI-34989, U01-HD-32632, U01-AI-34993, U01-AI-42590, N01-AI-35161, RO1 AI48483).

Abstract

Objective: To determine the association of race with clinical and laboratory outcomes after initiation of highly active antiretroviral therapy (HAART) in HIV-1-infected women in the United States.

Study Design: Prospective cohort study.

Participants: A total of 961 HIV-1-infected women participating in the Women's Interagency HIV Study initiating HAART between July 1, 1995 and September 30, 2003.

Results:

The 961 participants included 573 (59.6%) African American, 184 (19.2%) white, and 204 (21.2%) Hispanic women. African American women were older, less educated, initiated HAART at later calendar times, and were more likely to report pre-HAART use of cigarettes and cocaine, crack, or heroin than white women. Hispanic women were more likely to be depressed, to have an annual income of <$12,000, not to have completed high school, and to report not using ART at >1 visits after HAART initiation (55.4%), compared with white (27.7%) and African American women (44.7%).

Depression was significantly associated with poorer virologic response, increased likelihood of immunologic failure, incident ADI (AIDS defining illness), and a higher risk of all-cause, but not AIDS-related, death. Current drug use was associated with death from AIDS and a greater risk of incident ADI.

Depression reported following HAART initiation was associated with HAART discontinuation (RH = 1.40, P = 0.004). Race, however, was the stronger predictor of discontinuation, with white women less than half as likely as African American (RH = 0.43, P < 0.001) or Hispanic women (RH = 0.32, P < 0.001) to discontinue therapy independent of depression (data not shown). Thus, the higher prevalence of depression did not explain the higher rate of HAART discontinuation in African American and Hispanic women