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Comparative effectiveness of dual vs single-action antidepressants on HIV clinical outcomes in HIV-infected people with depression

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Abstract

Objective:

Depression is highly prevalent among people living with HIV/AIDS (PLWHA) and has deleterious effects on HIV clinical outcomes. We examined changes in depression symptoms, viral suppression and CD4 T-cells/mm3 among PLWHA diagnosed with depression who initiated antidepressant treatment during routine care, and compared the effectiveness of dual-action and single-action antidepressants for improving those outcomes.

Design:

Comparative effectiveness study of new user dual-action or single-action antidepressant treatment episodes occurring from 2004–2014 obtained from the Center for AIDS Research Network of Integrated Clinical Systems.

Methods:

We identified new user treatment episodes with no antidepressant use in the preceding 90 days. We completed intent-to-treat and per-protocol evaluations for the main analysis. Primary outcomes, were viral suppression (HIV viral load < 200 copies/mL) and CD4 T-cells/mm3. In a secondary analysis, we used the Patient Health Questionnaire-9 (PHQ-9) to evaluate changes in depression symptoms and remission (PHQ < 5). Generalized estimating equations with inverse probability of treatment weights were fitted to estimate treatment effects.

Results:

In weighted intent-to-treat analyses, the probability of viral suppression increased 16% after initiating antidepressants [95% Confidence Interval (CI) = (1.12,1.20)]. We observed an increase of 39 CD4 T-cells/mm3 after initiating antidepressants (30,48). Both the frequency of remission from depression and PHQ-9 scores improved after antidepressant initiation. Comparative effectiveness estimates were null in all models.

Conclusions:

Initiating antidepressant treatment was associated with improvements in depression, viral suppression and CD4 T-cells/mm3, highlighting the health benefits of treating depression in PLWHA. Dual- and single-action antidepressants had comparable effectiveness.

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