Photo Credit: Bogdan Malizkiy

Integrating depression screening as part of routine HIV care may be essential for sustaining viral suppression amidst life-changing events.

“After the onset of the COVID-19 pandemic in the US, numerous studies suggested that people were experiencing more mental health symptoms, including depressive symptoms,” Tarfa Verinumbe, MBBS, MPH, notes. “This raised a particular point of concern for us about people with HIV, given the established higher rates of depression in this patient population. The association between depression and poor health outcomes among people with HIV made this concern even more pressing.”

Specifically, Dr. Verinumbe says, researchers were concerned that if mental health symptoms worsened, they could potentially lead to adverse HIV-related outcomes. “After reviewing the literature, we found little evidence regarding these changes among people with HIV or how these changes may have affected viral suppression.”

For a study published in AIDS, Dr. Verinumbe and colleagues sought to address this research gap. They examined rates of depression before (March 2018 to February 2020) and during (September 2020 to February 2022) the COVID-19 pandemic among patients with HIV. The study included 793 people with HIV (mean age, 56), more than half (60%) of whom were men; most participants (88%) were Black.

Following the start of the COVID-19 pandemic, 60% of patients were consistently not depressed, while 9% were consistently depressed. Further, 15% of patients had worsened, and 16% experienced improvements in depression severity. Compared with people with HIV who were consistently not depressed, those whose depression worsened were 2.47 times more likely to be virally unsuppressed (95% CI, 1.09-5.55). Associations in other groups were not statistically significant.

Physician’s Weekly (PW) spoke with Dr. Verinumbe to learn more about the study findings and what they mean for the broader care of patients with HIV, including in the setting of major life-changing events.

PW: Can you elaborate on how the study was conducted?

Dr. Verinumbe: We selected our study sample based on routinely collected data about depression symptoms as measured by the Patient Health Questionnaire To describe the changes in depression severity, we compared depression severity pre-pandemic and during the COVID-19 era. These changes were categorized as improved, worsened, consistently non-depressed, and consistently depressed. Viral non-suppression served as our primary outcome, which we analyzed using the earliest viral load measurement that patients had after the COVID-19 era survey.

Which findings from your study are important to highlight?

Our study showed there were changes in depression severity observed among people with HIV. Importantly, we showed that those who experienced worsened depression severity were more likely to be virally non-suppressed. In contrast, people with improved depression severity were less likely to be virally non-suppressed, although our estimate was imprecise. For clinicians, this highlights the importance of routine monitoring for symptoms of depression among patients with HIV to ensure that patients with worsening symptoms are promptly identified and treated.

It is clear from our study that there were changes in depression severity among people with HIV after the onset of the pandemic. Although a considerable proportion had worsened depression or experienced consistent depression, most people with HIV were consistently not depressed during the pandemic. This finding was quite surprising, given what is known about depression among people with HIV.

What are the implications for clinicians?

The findings highlight the important role of “measurement-based care” when managing depression in people with HIV and supports existing evidence suggesting that adequate treatment could lead to better health outcomes for people with HIV. Overall, our study shows that the integration of screening for depression, along with prompt diagnosis and treatment of depression, as part of routine care for patients with HIV may be essential for sustaining viral suppression amidst life-changing events.

What would you like to see future research focus on?

There is still a lot of work to do. We have identified possible reasons for the changes observed in our study, including existing resilience among people with HIV. This could be an exciting area to explore in the future, especially related to the COVID-19 pandemic and other life-changing events.