More time with depression increases the risk of death of women with HIV
Frequent monitoring of depression may have the potential to reduce the risk of death.
The increase in life expectancy with depression is associated with an increased risk of death for women with HIV, according to published North American researchClinically Infectious Diseases.
During five years of follow-up, each 365 consecutive or intermittent days in depression increased the mortality risk of women with HIV in 72%.
A cumulative total of only 90 days with depression had a significant impact on the risk of death from any cause in women with HIV.
The impact of the cumulative duration of depression on the risk of mortality of women with HIV was independent of the severity of the most recent episode of depression in this or that woman with HIV and the "milder" depressive episode was not always "less" ).
"We found that the more time spent in depressive states, whether from consecutive or intermittent experience, had the power to increase mortality risk based on formula "Duration of depressive episode / antidepressant response", comment the authors.
The HIV disease whose AIDS is, as Dr. Angela taught me, the "tip of the iceberg" that appears clearly in our eyes
These findings have implications for the care of HIV disease, highlighting the importance of prompt diagnosis and treatment of depression, as well as the attentive, regular and helpful monitoring of the mood of a person who has already had "Just a depressive episode".
Depression is common in people with HIV. Overall prevalence is estimated between 20 and 40% and is even higher in women (30 to 60%).
Several studies have shown that depression is associated with an increased risk of mortality among HIV-positive women, but overall, with broad and broad margins of the age brackets of people with HIV simply.
Depression can increase the risk of death through multiple pathways, including less commitment to care, reduced self-care, lack of adherence to antiretroviral treatment or other drugs, substance abuse, and suicide.
Depression can also directly compromise immunity.
Previous research on the link between depression and mortality in people living with HIV tends to focus on depression as a binary measure, usually always versus never. In fact, in many people, depression is chronic and episodic and therefore is likely to have a cumulative effect on mortality over time.
Women's Interagency HIV Study (WIHS)
To investigate the impact of cumulative depression, Women's Interagency HIV Study (WIHS) developed a study to determine the cumulative burden of depression among women enrolled in the cohort and its effect on all-cause mortality.
The study population consisted of 818 women who started antiretroviral treatment from 1998 in the WIHS cohort. None of the women were taking antiretroviral therapy at the start of the study.
Using a validated measure (the CESD-R scale), depressive symptoms were assessed at baseline and then at routine semi-annual follow-up visits for up to five years. Translator's note: There is no way to "jump" the expression CESD-Rwithout undermining the understanding of the text and the methods used in the study. I looked for the water "in the source and established, in the puddle, a link to the source and I leave this summary:
The CESD-R is a screening test for depression and depressive disorder.
The CESD-R measures the symptoms defined by the Diagnostic and Statistical Manual of the American Psychiatric Association.
O (DSM-V) for a major depressive episode.
Middle-age: Women with HIV participating in the study were in the average age range of 38 years.
Two-thirds of the women with HIV were black. The mean cell count CD4 in the baseline and the viral load were of 438 cells/ Mm3and 3160 copies / ml3respectively.
The follow-up time of women with HIV and depression and the statistical result
The women were followed up for an average of 4,8 years and contributed a total of 3292 people-years of follow-up.
There were 94 deaths, a all-cause mortality rate of 2,9 per 100 people-year.
Of the study population, 53% were assessed as never having depression during the follow-up period.
At the time of the last follow up, the median cumulative number of days in depressed state (CDWD) was 366 days.
CDWD was higher among women who died than women who remained on treatment until the end of the study (435 vs 355 days).
The authors calculated that each additional 365 days living with depression was associated with an increase of 72% in the risk of all-cause mortality (HR = 1,72, IC 95%, 1,34-2,20, p <0,001).
An episode of depression of 91 days seems something small ... But ...
A cumulative burden of only 91 days also significantly increased the risk of mortality (HR = 1,14; 95% CI, 1,08-1,22, p <0,001).There was a significant association between the total number of days with depression and the high mortality risk when the investigators took into consideration the severity of depression at the beginning and the last follow-up visit before death (p = 0,005). Although much of the data from the study was collected during a period in which antiretroviral treatment was generally postponed until the CD4 cell count fell below 350 cells / mm3, and women remained out of treatment for most of the follow-up period, the researchers say their results are still relevant to an era in which antiretroviral treatment is recommended for all women.
Antiretroviral Therapy and Depression in Women with HIV
"Our exploratory analysis did not show that receipt of antiretroviral therapy moderates the relationship between depression, consistent with previous surveys using WIHS data."
Researchers say the findings may not be generalizable for men living with HIV, as women reported a higher level of depressive symptoms than men with HIV in previous research.
Researchers believe their findings have important implications for the routine care of women with HIV.
"Our findings highlighting the importance of the durational component of depression have important implications for current practices used in primary care settings for HIV," they write. "At present, HIV treatment guidelines recommend monitoring patients with stable viral loads every six months. However, we found that CDWD less than 182 days increases the risk of mortality. Thus, more frequent monitoring of depressed patients in conjunction with integrated depression protocols designed to shorten the course of depressive episodes could offset the additional accumulation of mortality risk. "
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Translated into 2018 by Claudio Souza of the originalMore time with depression increases the risk of death for women with HIV, written by Michael Carter originally published: 11 April 2018
Reviewed By Mara Macedo