- Scientists have found that depression is relatively common in people with HIV
- Screening and treatment for depression could increase viral suppression rates by 15%
- CDC researchers recommend enhanced screening and treatment of depression at HIV clinics
Research has found that mental health conditions are common among people with HIV. Depression is usually the most commonly diagnosed mental health issue. Some scientists estimate that rates of depression are about threefold greater in people with HIV compared to people without HIV. A study published earlier this year analysed data from more than 1,288 people with HIV living in Ontario and found that about 40% had depression.
According to a team of scientists at the U.S. Centers for Disease Control and Prevention (CDC), depression is associated with the following:
- concentration impairment
- feelings of worthlessness
The scientists note that these issues “often interfere with the ability and motivation to carry out important life activities. For [people with HIV], this can include adherence to HIV and other medication and care activities that prevent comorbidities and HIV disease progression.”
Adherence to effective HIV treatment (ART) is essential in order to achieve and maintain a suppressed viral load. A suppressed viral load has important benefits. Many studies have found that people on ART who have a suppressed viral load can expect a near-normal life expectancy (all other things being equal). Another benefit is that people whose viral loads are suppressed on ART do not pass on the virus to their sexual partners. However, if the full benefits of ART are to be realized, people need screening for depression and, if diagnosed, a discussion about treatment options.
The CDC researchers used an updated and previously validated computer model to compare different possible interventions on the health of people with HIV. The computer model was inputted with anonymized health information based on a representative sample of people with HIV in the U.S.
The two interventions were as follows:
Enhanced depression diagnosis and treatment – In this scenario, every person with HIV is assessed for depression; if they are diagnosed, they receive treatment, and half of the people on treatment go into remission from depression.
Status quo – 45% of people with depression get diagnosed; around 55% of those diagnosed get treatment for depression, with 33% of those on treatment going into remission from depression.
Overall, when the enhanced screening and treatment option was modelled, researchers found that about 15% more people with depression achieved a suppressed viral load than if the status quo was used.
Bear in mind
We did not provide extensive details about the scenarios used by the researchers as no computer model is perfect. However, the main point of the present study is that enhanced screening and use of treatment for depression is likely to help a significant fraction of people with HIV.
The researchers did not model the impact of psychological treatments for depression. These can also be beneficial for some people with HIV who have depression.
It is possible that the computer model overestimated the impact of depression treatment, as some people could subsequently relapse after having initially recovered from depression.
The researchers stated that “even when mental health services are available to people with HIV, mental health stigma may act as a barrier to their use.” There may also be social or structural factors that deter the acceptance and use of treatment for depression among vulnerable and historically mistreated populations.
It is also possible that some people with depression could spontaneously recover. The researchers stated that this is most likely to happen in people with mild depression.
For the future
The researchers stated that other studies have found that “routine screening for depression has clear benefits. In the HIV care setting, identifying and then adequately treating [all people with HIV who are depressed] would not only advance progress to our national prevention goals through its impact on viral suppression, but it would advance progress on new targets for quality of life for [people with HIV]. Specifically, by addressing unmet mental health needs, closing the gaps in the depression care continuum would improve health and subsequently quality of life for a notable proportion of people with HIV who have been diagnosed with depression.”
If progress against depression in people with HIV and society at large is to be made, further investment in mental health services is needed.
—Sean R. Hosein
- Koenig LJ, Khurana N, Islam MH, et al. Closing the gaps in the continuum of depression care for persons with HIV: modeling the impact on viral suppression in the United States. AIDS. 2023 Jun 1;37(7):1147-1156.
- Pence BW, Gaynes BN. Time to get it right: investing in the mental wellbeing of people living with HIV. AIDS. 2023 Jun 1;37(7):1167-1169.
- Mental Health Commission of Canada. Strengthening the Case for Investing in Canada’s Mental Health System: Economic Considerations. March 2017.
- Christensen BL, Tavangar F, Kroch AE, et al. Previous syphilis not associated with neurocognitive outcomes in people living with human immunodeficiency virus in Ontario, Canada. Sexually Transmitted Diseases. 2023 Jan 1;50(1):34-41.