The effect of antidepressant treatment on viral suppression among people with HIV diagnosed with depression in an urban clinic, 2012-2023.

Abstract

Objective: To estimate the effect of antidepressant initiation on viral non-suppression among people with HIV (PWH) with clinically recognized, untreated depression.

Design: Retrospective, observational cohort study.

Methods: We included clinical diagnoses of depression from January 2012-June 2022 among PWH in the Johns Hopkins HIV Clinical Cohort without another serious psychiatric illness who had initiated antiretroviral therapy. We excluded diagnoses less than 90 days from a prior diagnosis, antidepressant prescription, or >1 mental health visits. We estimated the association between initiating an antidepressant within 1 month of the index depression diagnosis and viral load non-suppression (>200 copies/mL) on the first viral load 3-12 months subsequent. We adjusted for a comprehensive set of demographic and clinical confounders.

Results: We included 2,346 depression diagnoses among 946 patients; patients initiated an antidepressant following 16%. The risk of viral non-suppression in the absence of antidepressant treatment was 15.6% (95% confidence interval [CI]: 13.1, 18.4). Antidepressant initiation was not associated with viral non-suppression (risk difference: 0.5%; 95% CI: -3.7, 4.8) or secondary outcomes: improvement or resolution of depressive symptoms or adherence to scheduled clinic visits.

Conclusions: In this sample of patients with as-yet-untreated depression, in a setting with co-located, low-barrier psychiatric services, antidepressant treatment was not associated with improved viral suppression. Pharmacologic management of depression has documented benefits in other studies. However, there may be a subset of PWH with depression who have been previously unsuccessfully treated with antidepressants who are less likely to respond to approved pharmacologic options and who require different interventions to improve their viral suppression.