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By Amy Norton
NEW YORK, Mar 20 (Reuters Health) - Depression among HIV patients is common, and studies have shown HIV-positive women to be more susceptible than men to depressive symptoms. Now new research suggests that this psychological factor may speed women's progression to AIDS.
In a study of 765 women with HIV, researchers found that those with chronic depression at the study's start were twice as likely to have died from AIDS 7 years later. Nearly one quarter of women who were chronically depressed died during the study, compared with just 8% of women with limited or no symptoms of depression. When other factors such as treatment regimens were weighed, chronic depression remained linked to a twofold increase in death risk.
Dr. Jeannette R. Ickovics of Yale University in New Haven, Connecticut, led the study. The findings are published in the March 21st issue of The Journal of the American Medical Association.
Overall, depression was a major problem for women in this study. Forty-two percent suffered from chronic depression, while 35% had "intermittent" symptoms. According to Ickovics and her colleagues, these findings highlight the importance of making depression treatment part of HIV treatment.
"What we think this indicates is that doctors need to screen for depression," said study co-author Dr. Merle E. Hamburger, a researcher at the Centers for Disease Control and Prevention in Atlanta, Georgia.
Some HIV patients, he told Reuters Health, may need to be referred for psychological care, be it counseling or antidepressant drugs.
Depression has long been linked to declines in physical health, including an increased risk of dying from heart disease. Some studies have indicated that depression may accelerate the progression of HIV to AIDS, but, according to the current report, no studies have focused on this connection among HIV-positive women.
It is difficult to weed out whether depression is the cause or result of declining health, according to Hamburger.
But this study indicated depression helped spur the patients' progression, independent of physical markers of declining health, the authors report. Among women with no apparent HIV symptoms at the start of the study, those with chronic depression were nearly four times more likely to die than were women with few depressive symptoms.
It does appear depression has an impact "over and above" the effects of just "getting sicker," Hamburger said.
Exactly why depression would speed the progression to AIDS remains unclear. Research shows depressed HIV patients are less likely to stick with their drug regimens. And, Ickovics and colleagues note, depression may also directly impair the immune system, which is already under heavy assault in HIV patients.
SOURCE: The Journal of the American Medical Association 2001;285:1466-1474.
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