Untreated depression among persons living with human immunodeficiency virus in Kazakhstan: A cross-sectional study

Dina Terloyeva, Zhamilya Nugmanova, Gulzhakhan M Akhmetova, Aikan A. Akanov, Nimish Patel, Victoria Lazariu, Lisa J. Norelli, Louise‐Anne McNutt

2018

Full text Open access: Gold Metadata (CSL-JSON)
DOI 10.1371/journal.pone.0193976
Data confidence 70 medium
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Abstract

BACKGROUND: In Kazakhstan, scarce official prevalence data exists for mood disorders. This study investigates the occurrence of depressive symptoms among people living with HIV/AIDS (PLWHA), and the relationship between depressive symptoms, HIV treatment initiation and antiretroviral treatment (ART) adherence. METHODS: A cross-sectional study was conducted among patients seen at the Almaty AIDS Center between April and December 2013. Two data sources were used: 1) self-administered survey that included the Patient Health Questionnaire (PHQ-9) to capture depression symptoms and 2) medical record review. Two primary outcomes were evaluated with log-binomial models and Fisher's exact test: the relationship between depression symptoms and 1) HIV treatment group, and 2) HIV adherence. RESULTS: Of the 564 participants, 9.9% reported symptoms consistent with a depressive disorder. None had received treatment for depression. Among those not on ART, a relationship between depressive symptoms and low CD4 counts (≤ 350 cells/mm3) was evident (7.1% for CD4 ≤ 350 cells/mm3 vs. 0.9% for CD4 > 350 cells/mm3, p = 0.029). In multivariable analysis, a higher prevalence of depressive symptoms was statistically associated with ART treatment, positive hepatitis C virus (HCV) status, and being unmarried. For those taking ART, treatment adherence was not statistically associated with a lower prevalence of depressive symptoms (12.5% vs 20.0%, p = 0.176); limited power may have impacted statistical significance. CONCLUSIONS: Untreated depression was found among PLWHA suggesting the need to evaluate access to psychiatric treatment. A collaborative strategy may be helpful to optimize HIV treatment outcomes.