TY - JOUR
T1 - The effect of antidepressant treatment on HIV and depression outcomes
T2 - Results from a randomized trial
AU - Pence, Brian W.
AU - Gaynes, Bradley N.
AU - Adams, Julie L.
AU - Thielman, Nathan M.
AU - Heine, Amy D.
AU - Mugavero, Michael J.
AU - McGuinness, Teena
AU - Raper, James L.
AU - Willig, James H.
AU - Shirey, Kristen G.
AU - Ogle, Michelle
AU - Turner, Elizabeth L.
AU - Quinlivan, E. Byrd
N1 - Funding Information:
Funding/support: This work was supported by grant R01MH086362 of the National Institute of Mental Health and the National Institute for Nursing Research, National Institutes of Health, Bethesda, Maryland, USA. Support for the design and conduct of the study was also provided by the NIH-funded Centers for AIDS Research at the University of North Carolina at Chapel Hill, Duke University, and the University of Alabama at Birmingham (P30-AI50410, P30-AI064518, and P30-AI027767).
Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/9/24
Y1 - 2015/9/24
N2 - Background: Depression is a major barrier to HIV treatment outcomes. Objective: To test whether antidepressant management decision support integrated into HIV care improves antiretroviral adherence and depression morbidity. Design: Pseudo-cluster randomized trial. Setting: Four US infectious diseases clinics. Participants: HIV-infected adults with major depressive disorder. Intervention: Measurement-based care (MBC)-depression care managers used systematic metrics to give HIV primary-care clinicians standardized antidepressant treatment recommendations. Measurements: Primary-antiretroviral medication adherence (monthly unannounced telephone-based pill counts for 12 months). Primary time-point-6 months. Secondary-depressive severity, depression remission, depression-free days, measured quarterly for 12 months. Results: From 2010 to 2013, 149 participants were randomized to intervention and 155 to usual care. Participants were mostly men, Black, non-Hispanic, unemployed, and virally suppressed with high baseline self-reported antiretroviral adherence and depressive severity. Over follow-up, no differences between arms in antiretroviral adherence or other HIV outcomes were apparent. At 6 months, depressive severity was lower among intervention participants than usual care [mean difference-3.7, 95% confidence interval (CI)-5.6,-1.7], probability of depression remission was higher [risk difference 13%, 95% CI 1%, 25%), and suicidal ideation was lower (risk difference-18%, 95% CI-30%,-6%). By 12 months, the arms had comparable mental health outcomes. Intervention arm participants experienced an average of 29 (95% CI: 1-57) more depression-free days over 12 months. Conclusion: In the largest trial of its kind among HIV-infected adults, MBC did not improve HIV outcomes, possibly because of high baseline adherence, but achieved clinically significant depression improvements and increased depression-free days. MBC may be an effective, resource-efficient approach to reducing depression morbidity among HIV patients.
AB - Background: Depression is a major barrier to HIV treatment outcomes. Objective: To test whether antidepressant management decision support integrated into HIV care improves antiretroviral adherence and depression morbidity. Design: Pseudo-cluster randomized trial. Setting: Four US infectious diseases clinics. Participants: HIV-infected adults with major depressive disorder. Intervention: Measurement-based care (MBC)-depression care managers used systematic metrics to give HIV primary-care clinicians standardized antidepressant treatment recommendations. Measurements: Primary-antiretroviral medication adherence (monthly unannounced telephone-based pill counts for 12 months). Primary time-point-6 months. Secondary-depressive severity, depression remission, depression-free days, measured quarterly for 12 months. Results: From 2010 to 2013, 149 participants were randomized to intervention and 155 to usual care. Participants were mostly men, Black, non-Hispanic, unemployed, and virally suppressed with high baseline self-reported antiretroviral adherence and depressive severity. Over follow-up, no differences between arms in antiretroviral adherence or other HIV outcomes were apparent. At 6 months, depressive severity was lower among intervention participants than usual care [mean difference-3.7, 95% confidence interval (CI)-5.6,-1.7], probability of depression remission was higher [risk difference 13%, 95% CI 1%, 25%), and suicidal ideation was lower (risk difference-18%, 95% CI-30%,-6%). By 12 months, the arms had comparable mental health outcomes. Intervention arm participants experienced an average of 29 (95% CI: 1-57) more depression-free days over 12 months. Conclusion: In the largest trial of its kind among HIV-infected adults, MBC did not improve HIV outcomes, possibly because of high baseline adherence, but achieved clinically significant depression improvements and increased depression-free days. MBC may be an effective, resource-efficient approach to reducing depression morbidity among HIV patients.
KW - HIV
KW - antiretroviral adherence
KW - depression
KW - measurement-based care depression treatment
KW - pseudo-cluster randomization
KW - randomized trial
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U2 - 10.1097/QAD.0000000000000797
DO - 10.1097/QAD.0000000000000797
M3 - Article
C2 - 26134881
AN - SCOPUS:84965025725
SN - 0269-9370
VL - 29
SP - 1975
EP - 1986
JO - AIDS
JF - AIDS
IS - 15
ER -
