HIV Care Continuum: Effects of Depression, Alcohol Use on Early Retention in ART
In the bivariate analysis, loss from care was associated with depression, alcohol use disorder, higher levels of internalized stigma, and decreased quality of life.
Both alcohol use and depression are associated with increased disengagement from antiretroviral therapy for patients with HIV in South Africa, according to the results of a recent study published in PLoS ONE.
In this prospective cohort study, 136 people living with HIV in South Africa who were initiating antiretroviral therapy were enrolled. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale, and alcohol use disorder was evaluated with the CAGE questionnaire. Researchers also measured internalized stigma and quality of life in participants. The associations between mental health variables and 6-month retention in care and viral suppression were evaluated.
A total of 33% of participants screened positive for depression, 49% for anxiety, and 33% for alcohol use disorder at baseline. At 6 months, 71% of participants were still receiving antiretroviral therapy, and 40% of participants who remained in care had a viral load of <50 copies/mL.
Lower rates of care retention were reported for participants with depression (49% vs 77%; P <.01) and with alcohol use disorder (52% vs 76%; P <.01). After adjustment for age, levels of internalized stigma, and decreased quality of life, depression (odds ratio, 3.46) and alcohol use disorder (odds ratio, 3.89) were associated with increased odds of disengaging from care.
No association between HIV RNA results and depression or alcohol use scores were found. The researchers suggested this may have been because of the small sample size and a high loss of participants with higher depression, alcohol use disorder, and stigma scores.
In an interview with Infectious Disease Advisor, Christopher Hoffmann, MD, MPH, associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland, explained that the study results "highlight that not only are depression and alcohol use conditions common, but that they are leading to worse outcomes in HIV care programs." He concluded that clinicians "should not overlook depression and alcohol use disorder. Without screening for these conditions, they can be easily missed and may affect treatment outcomes."
Cichowitz C, Maraba N, Hamilton R, Charalambous S, Hoffmann CJ. Depression and alcohol use disorder at antiretroviral therapy initiation led to disengagement from care in South Africa. PLoS One. 2017;12:e0189820. doi: 10.1371/journal.pone.0189820