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. 2021 Feb 15:281:208-215.
doi: 10.1016/j.jad.2020.12.024. Epub 2020 Dec 9.

Depression, antiretroviral therapy initiation, and HIV viral suppression among people who inject drugs in Vietnam

Sara N Levintow  1 , Brian W Pence  2 , Kimberly A Powers  2 , Alexander Breskin  3 , Teerada Sripaipan  4 , Tran Viet Ha  5 , Viet Anh Chu  5 , Vu Minh Quan  6 , Carl A Latkin  7 , Vivian F Go  4
Affiliations

Depression, antiretroviral therapy initiation, and HIV viral suppression among people who inject drugs in Vietnam

Sara N Levintow et al. J Affect Disord. .

Abstract

Background: The burden of depression is high among people who inject drugs (PWID) and may contribute to the spread of HIV through poor treatment engagement and persistent viremia. We estimated the effects of depression on antiretroviral therapy (ART) initiation and viral suppression among PWID living with HIV.

Methods: Longitudinal data were collected from 455 PWID living with HIV in Vietnam during 2009-2013. We estimated the 6- and 12-month cumulative incidence of ART initiation and viral suppression, accounting for time-varying confounding, competing events, and missing data. The cumulative incidence difference (CID) contrasted the incidence of each outcome had participants always vs. never experienced severe depressive symptoms across study visits to date.

Results: Severe depressive symptoms decreased the cumulative incidence of ART initiation, with CID values comparing always vs. never having severe depressive symptoms of -7.5 percentage points (95% CI: -17.2, 2.2) at 6 months and -7.1 (95% CI: -17.9, 3.7) at 12 months. There was no appreciable difference in the cumulative incidence of viral suppression at 6 months (CID = 0.3, 95% CI: -11.3, 11.9) or 12 months (CID = 2.0, 95% CI: -21.8, 25.8).

Limitations: Discrepancies between the ART initiation and viral suppression outcomes could be due to under-reporting of ART use and missing data on viral load.

Conclusions: Future work probing the seemingly antagonistic effect of depression on treatment uptake - but not viral suppression - will inform the design of interventions promoting HIV clinical outcomes and reducing onward transmission among PWID.

Keywords: Antiretroviral therapy; Depression; HIV; People who inject drugs; Viral suppression.

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Conflict of interest statement

CONFLICTS OF INTEREST

No authors have any actual or potential conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.. Estimates of 6-month and 12-month cumulative incidence of ART initiation and viral suppression.
The study sample for the ART initiation outcome was n=397 participants without ART use at baseline, and the study sample for the viral suppression outcome was n=342 participants without viral suppression at baseline.
Figure 2.
Figure 2.. Estimates of 6-month and 12-month cumulative incidence differences for ART initiation and viral suppression, contrasting the always-depressed scenario with the never-depressed scenario.
The study sample for the ART initiation outcome was n=397 participants without ART use at baseline, and the study sample for the viral suppression outcome was n=342 participants without viral suppression at baseline.
See this image and copyright information in PMC

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