Journal Article

Mind the Gap: Gaps in Antidepressant Treatment, Treatment Adjustments, and Outcomes among Patients in Routine HIV Care in a Multisite U.S. Clinical Cohort

Bengtson, Angela M., Pence, Brian W., Gaynes, Bradley N., Cholera, Rushina, Fredericksen, Rob, O’Clerigh, Conall, Mathews, W. Christopher, Mimiaga, Matthew J., Safren, Steven, Napravnik, Sonia, Heine, Amy, Cole, Steven R., Crane, Heidi M., Moore, Richard, Mugavero, Michael J., Christopoulos, Katerina

2017

Overview

Depression affects 20-30% of HIV-infected patients and is associated with worse HIV outcomes. Although effective depression treatment is available, depression is largely untreated or undertreated in this population. We quantified gaps in antidepressant treatment, treatment adjustments, and outcomes among US patients in routine HIV care in the nationally distributed CNICS observational clinical cohort. This cohort combines detailed clinical data with regular, self-reported depressive severity assessments (Patient Health Questionnaire-9, PHQ-9). We considered whether participants with likely depression received antidepressants, whether participants on antidepressants with persistently high depressive symptoms received timely dose adjustments, and whether participants achieved depression remission. We considered a cross-sectional analysis (6,219 participants in care in 2011-2012) and a prospective analysis (2,936 participants newly initiating CNICS care when PHQ-9 screening was active). The cross-sectional sample was 87% male, 53% Caucasian, 25% African American, and 18% Hispanic; the prospective sample was similar. In both samples, 39-44% had likely depression, with 44-60% of those receiving antidepressants. Of participants receiving antidepressants, 20-26% experienced persistently high depressive symptoms; only a small minority of those received antidepressant dose adjustments. Overall, 35-40% of participants on antidepressants achieved full depression remission. Remission among participants with persistently high depressive symptoms was rare regardless of dose adjustments. In this large, diverse cohort of US patients engaged in routine HIV care, we observed large gaps in antidepressant treatment, timely dose adjustment to address persistently high depressive symptoms, and antidepressant treatment outcomes. These results highlight the importance of more effective pharmacologic depression treatment models for HIV-infected patients.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adult / AIDS / Anti-HIV Agents - therapeutic use / Antidepressants / Antidepressive Agents - therapeutic use / Biology and Life Sciences / Clinical outcomes / Cohort analysis / Collaboration / Cross-Sectional Studies / Depression (Mood disorder) / Depression - complications / Depression - drug therapy / Depression - psychology / Depression - virology / Diagnostic Self Evaluation / Dosage and administration / Drug Administration Schedule / Drug dosages / Drug therapy / Epidemiology / Female / HIV / HIV Infections - complications / HIV Infections - drug therapy / HIV Infections - psychology / HIV Infections - virology / HIV patients / Hospitals / Human immunodeficiency virus / Humans / Infections / Infectious diseases / Lentivirus / Male / Medicine / Medicine and Health Sciences / Mental depression / Middle Aged / Patients / Pharmacology / Primary care / Prospective Studies / Psychiatry / Psychological aspects / Psychotherapy / Public health / Remission / Remission Induction / Retroviridae / Risk factors / Severity of Illness Index / Social Sciences / Treatment Outcome / Tricyclic antidepressants