Clinical importance of HIV and depressive symptoms among veterans with HIV infection

Abstract

Objective: To compare the clinical importance (association with illness severity and survival) of depressive and HIV symptoms among veterans with HIV infection.

Design: Cross-sectional study; survival analysis.

Setting: Infectious Disease Clinics at 3 VA Medical Centers.

Participants: HIV-infected patients (N = 881) and their health care providers from June 1999 through July 2000.

Measurements and main results: Depressive symptoms were assessed using the 10-item Centers for Epidemiologic Studies Depression Scale (CES-D). Patient baseline survey included an HIV Symptom Index measuring the frequency and bother of 20 common symptoms. Providers were surveyed on patients' illness severity, and survival data were obtained from VA death records. Of 881 patients, 46% had significant depressive symptoms (CES-D >/=10). Increasing depression symptom severity was associated with increasing HIV symptom frequency (P <.001) and bother (P <.001). Multiple regression results revealed that having moderate or severe depressive symptoms was not associated with provider-reported illness severity or survival. However, HIV symptoms were significantly associated with provider-reported illness severity (P <.01) and survival (P =.05), after adjusting for moderate and severe depressive symptoms, CD4 cell count/mm3, viral load, age, race, and antiretroviral use.

Conclusions: Depression, while common in this sample, was not associated with illness severity or mortality after adjusting for HIV symptoms. HIV symptoms are associated with severity of illness and survival regardless of patients' severity of depressive symptoms. This suggests that equal medical consideration should be given to HIV symptoms presented by HIV-infected patients regardless of their depression status, rather than automatically attributing medical complaints to depression.

FIGURE 1

Symptom frequency by depression severity level. In all cases, differences in symptom frequency were significant at P < .001 based on Cochran Test for Trend.