The Impact of Cumulative Depression Along the HIV Care Continuum in Women Living With HIV During the Era of Universal Antiretroviral Treatment

Jon C. Mills, Brian W. Pence, Andrew Edmonds, Adebola Adedimeji, Rebecca M. Schwartz, Seble Kassaye, Jennifer Cocohoba, Mardge H. Cohen, Gretchen Neigh, Margaret A. Fischl, Mirjam Colette Kempf, Adaora A. Adimora

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Data are limited on cumulative impacts of depression on engagement in care and HIV outcomes in women living with HIV (WLWH) during the era of universal antiretroviral therapy (ART). Understanding the relationship of accumulated depression with HIV disease management may help identify benefits of interventions to reduce severity and duration of depressive episodes. SETTING: A cohort of WLWH (N = 1491) from the Women's Interagency HIV Study at 9 sites across the US. METHODS: This longitudinal observational cohort study (2013-2017) followed WLWH for a maximum of 9 semiannual visits. Depression was quantified as a time-updated measure of percent of days depressed (PDD) created from repeated assessments using the Center for Epidemiologic Studies Depression scale. Marginal structural Poisson regression models were used to estimate the effects of PDD on the risks of missing an HIV care appointment, <95% ART adherence, and virological failure (≥200 copies/mL). RESULTS: The risk of missing an HIV care appointment [risk ratio (RR) = 1.16, 95% confidence interval = 0.93 to 1.45; risk difference (RD) = 0.01, -0.01 to 0.03], being <95% ART adherent (RR = 1.27, 1.06-1.52; RD = 0.04, -0.01 to 0.07), and virological failure (RR = 1.09, 1.01-1.18; RD = 0.01, -0.01 to 0.03) increased monotonically with increasing PDD (comparing those with 25 to those with 0 PDD). The total effect of PDD on virological failure was fully (%100) mediated by being <95% ART adherent. CONCLUSIONS: Time spent depressed increases the risk of virological failure through ART adherence, even in the era of universal ART regimes forgiving of imperfect adherence.

Original languageEnglish (US)
Pages (from-to)225-233
Number of pages9
JournalJournal of acquired immune deficiency syndromes (1999)
Volume82
Issue number3
DOIs
StatePublished - Nov 1 2019

Fingerprint

Continuity of Patient Care
HIV
Odds Ratio
Therapeutics
Appointments and Schedules
Disease Management
Observational Studies
Epidemiologic Studies
Cohort Studies
Confidence Intervals

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

The Impact of Cumulative Depression Along the HIV Care Continuum in Women Living With HIV During the Era of Universal Antiretroviral Treatment. / Mills, Jon C.; Pence, Brian W.; Edmonds, Andrew; Adedimeji, Adebola; Schwartz, Rebecca M.; Kassaye, Seble; Cocohoba, Jennifer; Cohen, Mardge H.; Neigh, Gretchen; Fischl, Margaret A.; Kempf, Mirjam Colette; Adimora, Adaora A.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 82, No. 3, 01.11.2019, p. 225-233.

Research output: Contribution to journalArticle

Mills, JC, Pence, BW, Edmonds, A, Adedimeji, A, Schwartz, RM, Kassaye, S, Cocohoba, J, Cohen, MH, Neigh, G, Fischl, MA, Kempf, MC & Adimora, AA 2019, 'The Impact of Cumulative Depression Along the HIV Care Continuum in Women Living With HIV During the Era of Universal Antiretroviral Treatment', Journal of acquired immune deficiency syndromes (1999), vol. 82, no. 3, pp. 225-233. https://doi.org/10.1097/QAI.0000000000002140
Mills, Jon C. ; Pence, Brian W. ; Edmonds, Andrew ; Adedimeji, Adebola ; Schwartz, Rebecca M. ; Kassaye, Seble ; Cocohoba, Jennifer ; Cohen, Mardge H. ; Neigh, Gretchen ; Fischl, Margaret A. ; Kempf, Mirjam Colette ; Adimora, Adaora A. / The Impact of Cumulative Depression Along the HIV Care Continuum in Women Living With HIV During the Era of Universal Antiretroviral Treatment. In: Journal of acquired immune deficiency syndromes (1999). 2019 ; Vol. 82, No. 3. pp. 225-233.
@article{fcbb22d2174c4839b8203d04342d37c3,
title = "The Impact of Cumulative Depression Along the HIV Care Continuum in Women Living With HIV During the Era of Universal Antiretroviral Treatment",
abstract = "BACKGROUND: Data are limited on cumulative impacts of depression on engagement in care and HIV outcomes in women living with HIV (WLWH) during the era of universal antiretroviral therapy (ART). Understanding the relationship of accumulated depression with HIV disease management may help identify benefits of interventions to reduce severity and duration of depressive episodes. SETTING: A cohort of WLWH (N = 1491) from the Women's Interagency HIV Study at 9 sites across the US. METHODS: This longitudinal observational cohort study (2013-2017) followed WLWH for a maximum of 9 semiannual visits. Depression was quantified as a time-updated measure of percent of days depressed (PDD) created from repeated assessments using the Center for Epidemiologic Studies Depression scale. Marginal structural Poisson regression models were used to estimate the effects of PDD on the risks of missing an HIV care appointment, <95{\%} ART adherence, and virological failure (≥200 copies/mL). RESULTS: The risk of missing an HIV care appointment [risk ratio (RR) = 1.16, 95{\%} confidence interval = 0.93 to 1.45; risk difference (RD) = 0.01, -0.01 to 0.03], being <95{\%} ART adherent (RR = 1.27, 1.06-1.52; RD = 0.04, -0.01 to 0.07), and virological failure (RR = 1.09, 1.01-1.18; RD = 0.01, -0.01 to 0.03) increased monotonically with increasing PDD (comparing those with 25 to those with 0 PDD). The total effect of PDD on virological failure was fully ({\%}100) mediated by being <95{\%} ART adherent. CONCLUSIONS: Time spent depressed increases the risk of virological failure through ART adherence, even in the era of universal ART regimes forgiving of imperfect adherence.",
author = "Mills, {Jon C.} and Pence, {Brian W.} and Andrew Edmonds and Adebola Adedimeji and Schwartz, {Rebecca M.} and Seble Kassaye and Jennifer Cocohoba and Cohen, {Mardge H.} and Gretchen Neigh and Fischl, {Margaret A.} and Kempf, {Mirjam Colette} and Adimora, {Adaora A.}",
year = "2019",
month = "11",
day = "1",
doi = "10.1097/QAI.0000000000002140",
language = "English (US)",
volume = "82",
pages = "225--233",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - The Impact of Cumulative Depression Along the HIV Care Continuum in Women Living With HIV During the Era of Universal Antiretroviral Treatment

AU - Mills, Jon C.

AU - Pence, Brian W.

AU - Edmonds, Andrew

AU - Adedimeji, Adebola

AU - Schwartz, Rebecca M.

AU - Kassaye, Seble

AU - Cocohoba, Jennifer

AU - Cohen, Mardge H.

AU - Neigh, Gretchen

AU - Fischl, Margaret A.

AU - Kempf, Mirjam Colette

AU - Adimora, Adaora A.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - BACKGROUND: Data are limited on cumulative impacts of depression on engagement in care and HIV outcomes in women living with HIV (WLWH) during the era of universal antiretroviral therapy (ART). Understanding the relationship of accumulated depression with HIV disease management may help identify benefits of interventions to reduce severity and duration of depressive episodes. SETTING: A cohort of WLWH (N = 1491) from the Women's Interagency HIV Study at 9 sites across the US. METHODS: This longitudinal observational cohort study (2013-2017) followed WLWH for a maximum of 9 semiannual visits. Depression was quantified as a time-updated measure of percent of days depressed (PDD) created from repeated assessments using the Center for Epidemiologic Studies Depression scale. Marginal structural Poisson regression models were used to estimate the effects of PDD on the risks of missing an HIV care appointment, <95% ART adherence, and virological failure (≥200 copies/mL). RESULTS: The risk of missing an HIV care appointment [risk ratio (RR) = 1.16, 95% confidence interval = 0.93 to 1.45; risk difference (RD) = 0.01, -0.01 to 0.03], being <95% ART adherent (RR = 1.27, 1.06-1.52; RD = 0.04, -0.01 to 0.07), and virological failure (RR = 1.09, 1.01-1.18; RD = 0.01, -0.01 to 0.03) increased monotonically with increasing PDD (comparing those with 25 to those with 0 PDD). The total effect of PDD on virological failure was fully (%100) mediated by being <95% ART adherent. CONCLUSIONS: Time spent depressed increases the risk of virological failure through ART adherence, even in the era of universal ART regimes forgiving of imperfect adherence.

AB - BACKGROUND: Data are limited on cumulative impacts of depression on engagement in care and HIV outcomes in women living with HIV (WLWH) during the era of universal antiretroviral therapy (ART). Understanding the relationship of accumulated depression with HIV disease management may help identify benefits of interventions to reduce severity and duration of depressive episodes. SETTING: A cohort of WLWH (N = 1491) from the Women's Interagency HIV Study at 9 sites across the US. METHODS: This longitudinal observational cohort study (2013-2017) followed WLWH for a maximum of 9 semiannual visits. Depression was quantified as a time-updated measure of percent of days depressed (PDD) created from repeated assessments using the Center for Epidemiologic Studies Depression scale. Marginal structural Poisson regression models were used to estimate the effects of PDD on the risks of missing an HIV care appointment, <95% ART adherence, and virological failure (≥200 copies/mL). RESULTS: The risk of missing an HIV care appointment [risk ratio (RR) = 1.16, 95% confidence interval = 0.93 to 1.45; risk difference (RD) = 0.01, -0.01 to 0.03], being <95% ART adherent (RR = 1.27, 1.06-1.52; RD = 0.04, -0.01 to 0.07), and virological failure (RR = 1.09, 1.01-1.18; RD = 0.01, -0.01 to 0.03) increased monotonically with increasing PDD (comparing those with 25 to those with 0 PDD). The total effect of PDD on virological failure was fully (%100) mediated by being <95% ART adherent. CONCLUSIONS: Time spent depressed increases the risk of virological failure through ART adherence, even in the era of universal ART regimes forgiving of imperfect adherence.

UR - http://www.scopus.com/inward/record.url?scp=85073183559&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073183559&partnerID=8YFLogxK

U2 - 10.1097/QAI.0000000000002140

DO - 10.1097/QAI.0000000000002140

M3 - Article

C2 - 31335585

AN - SCOPUS:85073183559

VL - 82

SP - 225

EP - 233

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 3

ER -