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The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial.

Publication ,  Journal Article
Pence, BW; Gaynes, BN; Adams, JL; Thielman, NM; Heine, AD; Mugavero, MJ; McGuinness, T; Raper, JL; Willig, JH; Shirey, KG; Ogle, M; Turner, EL ...
Published in: AIDS
September 24, 2015

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.

Duke Scholars

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Published In

AIDS

DOI

EISSN

1473-5571

Publication Date

September 24, 2015

Volume

29

Issue

15

Start / End Page

1975 / 1986

Location

England

Related Subject Headings

  • Virology
  • Treatment Outcome
  • Middle Aged
  • Medication Adherence
  • Male
  • Humans
  • HIV Infections
  • Female
  • Depression
  • Antidepressive Agents
 

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MLA
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Pence, B. W., Gaynes, B. N., Adams, J. L., Thielman, N. M., Heine, A. D., Mugavero, M. J., … Quinlivan, E. B. (2015). The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial. AIDS, 29(15), 1975–1986. https://doi.org/10.1097/QAD.0000000000000797
Pence, Brian W., Bradley N. Gaynes, Julie L. Adams, Nathan M. Thielman, Amy D. Heine, Michael J. Mugavero, Teena McGuinness, et al. “The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial.AIDS 29, no. 15 (September 24, 2015): 1975–86. https://doi.org/10.1097/QAD.0000000000000797.
Pence BW, Gaynes BN, Adams JL, Thielman NM, Heine AD, Mugavero MJ, et al. The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial. AIDS. 2015 Sep 24;29(15):1975–86.
Pence, Brian W., et al. “The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial.AIDS, vol. 29, no. 15, Sept. 2015, pp. 1975–86. Pubmed, doi:10.1097/QAD.0000000000000797.
Pence BW, Gaynes BN, Adams JL, Thielman NM, Heine AD, Mugavero MJ, McGuinness T, Raper JL, Willig JH, Shirey KG, Ogle M, Turner EL, Quinlivan EB. The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial. AIDS. 2015 Sep 24;29(15):1975–1986.

Published In

AIDS

DOI

EISSN

1473-5571

Publication Date

September 24, 2015

Volume

29

Issue

15

Start / End Page

1975 / 1986

Location

England

Related Subject Headings

  • Virology
  • Treatment Outcome
  • Middle Aged
  • Medication Adherence
  • Male
  • Humans
  • HIV Infections
  • Female
  • Depression
  • Antidepressive Agents