Prevalence, Virological Status, and Improvement of Depression Symptoms During a One-Year HIV Cohort Study

Friday, 28 July 2017

College of Nursing, University of Alabama in Huntsville, Huntsville, AL, USA
Sandra C. Jones, MSN
Department of Infectious Disease, St. Jude Children's Research Hospital, Memphis, TN, USA


Depression is reported as one of the most common co-morbidities of HIV infection (Simoni et al., 2011). Currently, the estimated prevalence of major depressive disorder among the HIV population ranges from 20 percent to as high as 37 percent (Bing et al., 2001; Valente, 2003). Persons who experienced an increase in depression symptoms also reported increases in viral loads (Kalichman, Difonzo, Austin, Luke, & Rompa, 2002). Available evidence supports that depression has a high association with non-adherence to HIV medication, missed medical appointments, and health status deterioration during HIV disease progression. The team investigated the prevalence of depression symptoms, the relationship of PHQ-9 scores with HIV virological status, and further explored possible measures to estimate times needed to improve PHQ-9 scores over the course of a one-year study.



Patient Health Questionnaire-9 (PHQ-9), a standard instrument for diagnosing depression in primary care was implemented with all patients seeking care at one non-profit organization in northeast Alabama, United States. Patients participated in PHQ-9 screenings during each medical appointment prior to meeting with the medical provider. The survey mechanism was integrated as part of the patient’s initial intake questionnaire. All responses were reviewed and recorded in the patient’s electronic medical records. Four hundred and eighty patients met specific criteria and participated in the study during the period from 1 January 2015 through 31 December 2015.



Fifty-five percent of the total participants recorded a PHQ-9 score of 10 or above. Interestingly, the group also achieved 90% of HIV viral suppression rate. An increase in PHQ-9 scores were found not to be statistically correlated with viral load and CD4. The Kaplan-Meier plot revealed that PHQ-9 improvements were noted approximately 160 days after the first PHQ-9 measurements were conducted.



This study emphasizes that depression is still an under diagnosed condition. Implementation of PHQ-9 screening at the clinical level could be the first step to alleviating this concern, regardless of the patient’s current virological status. Results from the screening will provide valuable insight into the patient’s emotional well-being. If warranted, proper depression medication treatment and multiple follow-up visits should be integrated as part of medical management services.