Trajectories of Depressive Symptoms, Neurocognitive Function, and Viral Suppression With Antiretroviral Therapy Among Youth With HIV Over 36 months
Jordan N Kohn, Matthew Shane Loop, Julie J Kim-Chang, Patricia A Garvie, John W Sleasman, Bernard Fischer, H Jonathon Rendina, Steven Paul Woods, Sharon L Nichols, Suzi Hong, Jordan N Kohn, Matthew Shane Loop, Julie J Kim-Chang, Patricia A Garvie, John W Sleasman, Bernard Fischer, H Jonathon Rendina, Steven Paul Woods, Sharon L Nichols, Suzi Hong
Abstract
Background: Depression and neurocognitive impairment are highly prevalent among persons living with HIV and associated with poorer clinical outcomes; however, longitudinal studies of depression-neurocognition relationships in youth living with HIV (YLWH), and the role of antiretroviral therapy (ART), are lacking. This study tested whether (1) depressive symptomatology, across somatic, cognitive, and affective symptom domains, improved with ART and (2) more severe depressive symptoms at baseline were associated with poorer neurocognitive function and poorer HIV suppression.
Setting: Data were collected from 181 YLWH (18-24 years) who were treatment-naive, a subset of whom (n = 116) initiated ART.
Methods: Participants were categorized into elevated (DS) or nonelevated (non-DS) depressive symptom groups at entry (Beck Depression Inventory-II ≥14) and followed for 36 months. Neurocognition (5-domain battery) and depressive symptoms were repeatedly assessed. Longitudinal models examined depressive symptomatology, neurocognition, and odds of HIV nonsuppression by group.
Results: Greater improvements in depressive symptoms were observed in the DS group over 36 months [beta = -0.14, (-0.24 to -0.03)], particularly within cognitive and affective domains. Verbal learning performance increased in the DS group [beta = 0.13, (0.01 to 0.24)], whereas psychomotor function improved somewhat in the non-DS group [beta = -0.10, (-0.22 to 0.00)]. Adjusted for ART adherence, odds of HIV nonsuppression did not significantly differ by group [odds ratio = 0.22, (0.04 to 1.23)]; however, greater somatic symptoms at study entry were associated with an increased risk of nonsuppression over time [odds ratio = 2.33 (1.07 to 5.68)].
Conclusion: Depressive symptoms were associated with differential neurocognitive trajectories, and somatic depressive symptoms at baseline may predict poorer subsequent HIV suppression. Identifying and treating depressive symptoms at ART initiation may benefit neurocognitive and clinical outcomes in YLWH.
Trial registration: ClinicalTrials.gov NCT00683579.
Conflict of interest statement
The authors have no conflicts of interest to disclose.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Figures
![Figure 1.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8131211/bin/nihms-1669652-f0001.jpg)
Figure 2.
Conditional mean Z-scores in neurocognitive…
Figure 2.
Conditional mean Z-scores in neurocognitive functional domains derived from linear mixed-effects models adjusted…
Figure 3.
Baseline risk factors for viral…
Figure 3.
Baseline risk factors for viral non-suppression during 3 years of ART. Logistic regression…
- Antiretroviral treatment initiation does not differentially alter neurocognitive functioning over time in youth with behaviorally acquired HIV.Nichols SL, Bethel J, Kapogiannis BG, Li T, Woods SP, Patton ED, Ren W, Thornton SE, Major-Wilson HO, Puga AM, Sleasman JW, Rudy BJ, Wilson CM, Garvie PA; Adolescent Medicine Trials Network for HIV/AIDS Interventions. Nichols SL, et al. J Neurovirol. 2016 Apr;22(2):218-30. doi: 10.1007/s13365-015-0389-0. Epub 2015 Oct 13. J Neurovirol. 2016. PMID: 26463526 Free PMC article.
- Brief Report: Linking Depressive Symptoms to Viral Nonsuppression Among Women With HIV Through Adherence Self-Efficacy and ART Adherence.Crockett KB, Entler KJ, Brodie E, Kempf MC, Konkle-Parker D, Wilson TE, Tien PC, Wingood G, Neilands TB, Johnson MO, Weiser SD, Turan JM, Turan B. Crockett KB, et al. J Acquir Immune Defic Syndr. 2020 Apr 1;83(4):340-344. doi: 10.1097/QAI.0000000000002268. J Acquir Immune Defic Syndr. 2020. PMID: 32097193 Free PMC article.
- Depression and neurocognitive performance in individuals with HIV/AIDS: 2-year follow-up.Gibbie T, Mijch A, Ellen S, Hoy J, Hutchison C, Wright E, Chua P, Judd F. Gibbie T, et al. HIV Med. 2006 Mar;7(2):112-21. doi: 10.1111/j.1468-1293.2006.00350.x. HIV Med. 2006. PMID: 16420256
- Depressive symptoms and neurocognitive performance among HIV-infected women.Fialho RM, Pereira M, Mendonça N, Ouakinin S. Fialho RM, et al. Women Health. 2013;53(2):117-34. doi: 10.1080/03630242.2013.767301. Women Health. 2013. PMID: 23517511
- Suicidal Ideation.Harmer B, Lee S, Duong TVH, Saadabadi A. Harmer B, et al. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 33351435 Free Books & Documents.
- Prevalence and related factors of depressive symptoms among HIV/AIDS in Ningbo, China: A cross-sectional study.Chen S, Hong H, Xu G. Chen S, et al. Front Psychiatry. 2022 Oct 10;13:1004318. doi: 10.3389/fpsyt.2022.1004318. eCollection 2022. Front Psychiatry. 2022. PMID: 36299546 Free PMC article.
- Peripheral inflammation and depressed mood independently predict neurocognitive worsening over 12 years.Ellis RJ, Heaton RK, Tang B, Collier AC, Marra CM, Gelman BB, Morgello S, Clifford DB, Sacktor N, Cookson D, Letendre S. Ellis RJ, et al. Brain Behav Immun Health. 2022 Mar 10;21:100437. doi: 10.1016/j.bbih.2022.100437. eCollection 2022 May. Brain Behav Immun Health. 2022. PMID: 35308084 Free PMC article.
- Research Support, N.I.H., Extramural
- Adolescent
- Anti-HIV Agents / therapeutic use
- Antiretroviral Therapy, Highly Active
- Cognitive Dysfunction / epidemiology*
- Cognitive Dysfunction / psychology
- Cognitive Dysfunction / virology*
- Depression / epidemiology*
- Depression / psychology
- Depression / virology*
- HIV Infections / drug therapy
- HIV Infections / pathology
- HIV Infections / psychology*
- Humans
- Longitudinal Studies
- Neuropsychological Tests
- Psychiatric Status Rating Scales
- RNA, Viral / blood
- Viral Load / drug effects
- Young Adult
- Anti-HIV Agents
- RNA, Viral
- ClinicalTrials.gov/NCT00683579
- Full Text Sources
- Other Literature Sources
- Medical
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![Figure 2.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8131211/bin/nihms-1669652-f0002.jpg)
Figure 3.
Baseline risk factors for viral…
Figure 3.
Baseline risk factors for viral non-suppression during 3 years of ART. Logistic regression…
- Antiretroviral treatment initiation does not differentially alter neurocognitive functioning over time in youth with behaviorally acquired HIV.Nichols SL, Bethel J, Kapogiannis BG, Li T, Woods SP, Patton ED, Ren W, Thornton SE, Major-Wilson HO, Puga AM, Sleasman JW, Rudy BJ, Wilson CM, Garvie PA; Adolescent Medicine Trials Network for HIV/AIDS Interventions. Nichols SL, et al. J Neurovirol. 2016 Apr;22(2):218-30. doi: 10.1007/s13365-015-0389-0. Epub 2015 Oct 13. J Neurovirol. 2016. PMID: 26463526 Free PMC article.
- Brief Report: Linking Depressive Symptoms to Viral Nonsuppression Among Women With HIV Through Adherence Self-Efficacy and ART Adherence.Crockett KB, Entler KJ, Brodie E, Kempf MC, Konkle-Parker D, Wilson TE, Tien PC, Wingood G, Neilands TB, Johnson MO, Weiser SD, Turan JM, Turan B. Crockett KB, et al. J Acquir Immune Defic Syndr. 2020 Apr 1;83(4):340-344. doi: 10.1097/QAI.0000000000002268. J Acquir Immune Defic Syndr. 2020. PMID: 32097193 Free PMC article.
- Depression and neurocognitive performance in individuals with HIV/AIDS: 2-year follow-up.Gibbie T, Mijch A, Ellen S, Hoy J, Hutchison C, Wright E, Chua P, Judd F. Gibbie T, et al. HIV Med. 2006 Mar;7(2):112-21. doi: 10.1111/j.1468-1293.2006.00350.x. HIV Med. 2006. PMID: 16420256
- Depressive symptoms and neurocognitive performance among HIV-infected women.Fialho RM, Pereira M, Mendonça N, Ouakinin S. Fialho RM, et al. Women Health. 2013;53(2):117-34. doi: 10.1080/03630242.2013.767301. Women Health. 2013. PMID: 23517511
- Suicidal Ideation.Harmer B, Lee S, Duong TVH, Saadabadi A. Harmer B, et al. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 33351435 Free Books & Documents.
- Prevalence and related factors of depressive symptoms among HIV/AIDS in Ningbo, China: A cross-sectional study.Chen S, Hong H, Xu G. Chen S, et al. Front Psychiatry. 2022 Oct 10;13:1004318. doi: 10.3389/fpsyt.2022.1004318. eCollection 2022. Front Psychiatry. 2022. PMID: 36299546 Free PMC article.
- Peripheral inflammation and depressed mood independently predict neurocognitive worsening over 12 years.Ellis RJ, Heaton RK, Tang B, Collier AC, Marra CM, Gelman BB, Morgello S, Clifford DB, Sacktor N, Cookson D, Letendre S. Ellis RJ, et al. Brain Behav Immun Health. 2022 Mar 10;21:100437. doi: 10.1016/j.bbih.2022.100437. eCollection 2022 May. Brain Behav Immun Health. 2022. PMID: 35308084 Free PMC article.
- Research Support, N.I.H., Extramural
- Adolescent
- Anti-HIV Agents / therapeutic use
- Antiretroviral Therapy, Highly Active
- Cognitive Dysfunction / epidemiology*
- Cognitive Dysfunction / psychology
- Cognitive Dysfunction / virology*
- Depression / epidemiology*
- Depression / psychology
- Depression / virology*
- HIV Infections / drug therapy
- HIV Infections / pathology
- HIV Infections / psychology*
- Humans
- Longitudinal Studies
- Neuropsychological Tests
- Psychiatric Status Rating Scales
- RNA, Viral / blood
- Viral Load / drug effects
- Young Adult
- Anti-HIV Agents
- RNA, Viral
- ClinicalTrials.gov/NCT00683579
- Full Text Sources
- Other Literature Sources
- Medical
![Figure 3.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8131211/bin/nihms-1669652-f0003.jpg)
Source: PubMed