Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

Comorbidities and depression in older adults with HIV

Richard J. Havlik A , Mark Brennan A B C and Stephen E. Karpiak A B
+ Author Affiliations
- Author Affiliations

A AIDS Community Research Initiative of America (ACRIA), ACRIA Center on HIV and Aging, 230 West 38th Street, 17th Floor, New York, NY 10018, USA.

B New York University College of Nursing, New York, NY 10003, USA.

C Corresponding author. Email: MBrennan@acria.org

Sexual Health 8(4) 551-559 https://doi.org/10.1071/SH11017
Submitted: 7 February 2011  Accepted: 24 May 2011   Published: 29 July 2011

Abstract

Objective: To investigate whether the high rates of depression found in older adults living with HIV are associated with the number and types of comorbidities. Methods: The Research on Older Adults with HIV (ROAH) study collected self-reported health data on ~1000 New York City HIV-positive men and women aged 50 years and older. Participants provided data on health problems experienced in the past year and depressive symptomatology (Center for Epidemiological Studies Depression Scale (CES-D)). Data were analysed using a non-parametric test of association and multiple regression analysis. Results: The correlation between CES-D scores and number of comorbidities was significant (r = 0.24). In multivariate analyses, depression remained a significant covariate of the number of comorbid conditions, in addition to female gender, inadequate income, history of drug and alcohol use, AIDS diagnosis and self-rated health. Correlations of depression with specific comorbidities varied. Significant correlations with sensory loss and dermatological problems were observed. Significant correlations existed with heart and respiratory conditions as well as fractures, but the directionality of these cross-sectional relationships is uncertain. Conclusions: The findings suggest the need for further longitudinal research to understand how high rates of depressive symptoms are related to comorbidities. Focussed clinical care that strives to prevent the collapse of the immune system must evolve into an effective treatment strategy for multimorbidities, where HIV is but one of many other chronic illnesses. If the management of depression continues to be a low priority, the older person with HIV may experience an avoidable reduction in life expectancy.

Additional keywords: epidemiology, medical care, USA.


References

[1]  Bing EG, Burnam MA, Longshore D, Fleishman JA, Donald Sherbourne C, London AS, et al Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry 2001; 58 721–8.
Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States.Crossref | GoogleScholarGoogle Scholar |

[2]  Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk of depressive disorders. Am J Psychiatry 2001; 158 725–30.
Meta-analysis of the relationship between HIV infection and risk of depressive disorders.Crossref | GoogleScholarGoogle Scholar |

[3]  Berg M, Mimiago M, Safren S. Mental health concerns of gay and bisexual men seeking mental health services. J Homosex 2008; 54 293–306.
Mental health concerns of gay and bisexual men seeking mental health services.Crossref | GoogleScholarGoogle Scholar |

[4]  Applebaum A, Brennan M. Mental health and depression. In: Brennan M, Karpiak SE, Cantor MH, Shippy RA, editors. Research on older adults with HIV: an in-depth examination of an emerging population. New York: Nova Science; 2009. pp. 27–34.

[5]  Grov C, Golub SA, Parsons JT, Brennan M, Karpiak SE. Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care 2010; 21 1–10.

[6]  MacReady N. Stigma, depression, isolation common among people with HIV or AIDS. New York: Medscape; 2010. Available online at: http://www.medscape.com/viewarticle/725819[verified January 2011].

[7]  Horberg MA, Silverberg M, Hurley L, Towner WJ, Klein DB, Bersoff-Matcha S, et al Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr 2008; 47 384–90.
Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy on clinical outcomes in HIV-infected patients.Crossref | GoogleScholarGoogle Scholar |

[8]  Tsai AC, Weiser SD, Petersen ML, Ragland K, Kushel MB, Bangsberg DR. A marginal structural model to estimate the causal effect of antidepressent medication treatment on viral suppression among homeless and marginally housed persons with HIV. Arch Gen Psychiatry 2010; 67 1282–90.
A marginal structural model to estimate the causal effect of antidepressent medication treatment on viral suppression among homeless and marginally housed persons with HIV.Crossref | GoogleScholarGoogle Scholar |

[9]  Zanjani F, Saboe K, Oslin D. Age differences in rates of mental health/substance abuse and behavioral care in HIV-positive adults. AIDS Patient Care and STDs 2007; 21 347–55.
Age differences in rates of mental health/substance abuse and behavioral care in HIV-positive adults.Crossref | GoogleScholarGoogle Scholar |

[10]  Aberg JA, Kaplan JE, Libman H, Emmanuel P, Anderson JR, Stone VE, et al Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2009; 49 651–81.
Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV Medicine Association of the Infectious Diseases Society of America.Crossref | GoogleScholarGoogle Scholar |

[11]  United States Senate Special Committee on Aging. HIV over fifty: exploring the new threat. Washington, D.C.: U.S. Government Printing Office: United States Senate Special Committee on Aging; 2005. Available online at: http://www.aging.senate.gov/hearing_detail.cfm?id=270655 [verified January 2011].

[12]  Negin J, Cumming RG. HIV infection in older adults in Sub-Saharan Africa: extrapolating prevalence from existing data. Bull World Health Organ 2010; 88 847–53.
HIV infection in older adults in Sub-Saharan Africa: extrapolating prevalence from existing data.Crossref | GoogleScholarGoogle Scholar |

[13]  Palella FJ, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, et al Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr 2006; 43 27–34.
Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study.Crossref | GoogleScholarGoogle Scholar |

[14]  Smit C, Geskus R, Walker S, Coutinho R, Porter K, Prins M, et al Effective therapy has altered the spectrum of cause-specific mortality following HIV seroconversion. AIDS 2006; 20 741–9.
Effective therapy has altered the spectrum of cause-specific mortality following HIV seroconversion.Crossref | GoogleScholarGoogle Scholar |

[15]  Havlik RJ. Health status, comorbidities, and health-related quality of life. In: Brennan M, Karpiak SE, Cantor MH, Shippy RA, editors. Research on older adults with HIV: an in-depth examination of an emerging population. New York: Nova Science; 2009. pp. 13–25.

[16]  Vance DE, Mugavero M, Willig J, Raper JL, Saag MS. Aging with HIV: a cross-sectional study of comorbidity prevalence and clinical characteristics across decades of life. J Assoc Nurses AIDS Care 2011; 363 2611–20.

[17]  Strategies for Management of Anti-Retroviral Therapy/INSIGHT D:A:D Study Groups Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients. AIDS 2008; 22 F17–24.
Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients.Crossref | GoogleScholarGoogle Scholar |

[18]  Patel P, Hanson DL, Sullivan PS, Novak RM, Moorman AC, Tong TC, et al Adult and Adolescent Spectrum of Disease Project and HIV Outpatient Study Investigators Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann Intern Med 2008; 148 728–36.

[19]  Friis-Møller N, Reiss P, Sabin CA, Weber R, d’Arminio Monforte A, El-Sadr W, et al Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med 2007; 356 1723–35.
Class of antiretroviral drugs and the risk of myocardial infarction.Crossref | GoogleScholarGoogle Scholar |

[20]  Gebo KA, Fleishman JA, Moore RD. Hospitalizations for metabolic conditions, opportunistic infections, and injection drug use among HIV patients: trends between 1996 and 2000 in 12 states. J Acquir Immune Defic Syndr 2005; 40 609–16.
Hospitalizations for metabolic conditions, opportunistic infections, and injection drug use among HIV patients: trends between 1996 and 2000 in 12 states.Crossref | GoogleScholarGoogle Scholar |

[21]  Braithwaite RS, Justice AC, Chang CC, Fusco JS, Raffanti SR, Wong JB, et al Estimating the proportion of patients infected with HIV who will die of comorbid diseases. Am J Med 2005; 118 890–8.
Estimating the proportion of patients infected with HIV who will die of comorbid diseases.Crossref | GoogleScholarGoogle Scholar |

[22]  Salmon-Ceron D, Lewden C, Morlat P, Bévilacqua S, Jougla E, Bonnet F, et al Liver disease as a major cause of death among HIV infected patients: role of hepatitis C and B viruses and alcohol. J Hepatol 2005; 42 799–805.
Liver disease as a major cause of death among HIV infected patients: role of hepatitis C and B viruses and alcohol.Crossref | GoogleScholarGoogle Scholar |

[23]  Bonnet F, Lewden C, May T, Heripret L, Jougla E, Bévilacqua S, et al Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy. Cancer 2004; 101 317–24.
Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar |

[24]  Lee Y, Choi K, Lee YK. Association of comorbidity with depressive symptoms in community-dwelling older persons. Gerontology 2001; 47 254–62.
Association of comorbidity with depressive symptoms in community-dwelling older persons.Crossref | GoogleScholarGoogle Scholar |

[25]  Lyness JM, Niculescu A, Xin T, Reynolds CF, Caine ED. The relationship of medical comorbidity and depression in older, primary care patients. Psychosomatics 2006; 47 435–9.
The relationship of medical comorbidity and depression in older, primary care patients.Crossref | GoogleScholarGoogle Scholar |

[26]  Kales HC, Valenstein M. Complexity in late-life depression: impact of confounding factors on diagnosis, treatment, and outcomes. J Geriatr Psychiatry Neurol 2002; 15 147–55.

[27]  Krishnan KRR, Delong M, Kraemer H, Carney R, Spiegel D, Gordon C, et al Comorbidity of depression with other medical diseases in the elderly. Biol Psychiatry 2002; 52 559–88.
Comorbidity of depression with other medical diseases in the elderly.Crossref | GoogleScholarGoogle Scholar |

[28]  Nabi H, Shipley MJ, Vahtera J, Hall M, Korkeila J, Marmot MG, et al Effects of depressive symptoms and coronary heart disease and their interactive associations on mortality in middle-aged adults: the Whitehall II cohort study. Heart 2010; 96 1645–50.

[29]  Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, et al Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med 2004; 66 305–15.
Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment.Crossref | GoogleScholarGoogle Scholar |

[30]  Eskandari F, Martinez PE, Torvik S, Phillips TM, Sternberg EM, Mistry S, et al Low bone mass in premenopausal women with depression. Arch Intern Med 2007; 167 2329–36.
Low bone mass in premenopausal women with depression.Crossref | GoogleScholarGoogle Scholar |

[31]  Brennan M, Karpiak SE, Cantor MH, Shippy RA, editors. Research on older adults with HIV: an in-depth examination of an emerging population. New York: Nova Science; 2009.

[32]  New York City Department of Health and Mental Hygiene. HIV epidemiology program 1st quarter report. Vol 4(1). New York: New York City Department of Health and Mental Hygiene; 2006. Available online at: http://www.nyc.gov/html/doh/downloads/pdf/dires/dires-2006-report-qtr1.pdf [verified April 2011].

[33]  Applebaum A, Brennan M. Substance and alcohol use. In: Brennan M, Karpiak SE, Cantor MH, Shippy RA, editors. Research on older adults with HIV: an in-depth examination of an emerging population. New York: Nova Science; 2009. pp. 35–42.

[34]  Radloff LS. The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas 1977; 1 385–401.
The CES-D scale: a self report depression scale for research in the general population.Crossref | GoogleScholarGoogle Scholar |

[35]  Cohen J, Cohen P. Applied multiple regression for the behavioral sciences (2nd edn). Hillsdale, NJ: Erlbaum Associates; 1983. pp. 181–220.

[36]  Dube MP, Sattler FR. Inflammation and complications of HIV disease. J Infect Dis 2010; 201 1783–5.
Inflammation and complications of HIV disease.Crossref | GoogleScholarGoogle Scholar |

[37]  Maes M, Kubera M, Obuchowiczwa E, Goehler L, Brzeszcz J. Depression’s multiple comorbidities explained by (neuro)inflammatory and oxidative & nitrosative stress pathways. Neuroendocrinol Lett 2011; 32 7–24.

[38]  Horowitz A, Reinhardt JP, Kennedy G. Major and subthreshold depression among older adults seeking vision rehabilitation services. Am J Geriatr Psychiatry 2005; 13 180–7.

[39]  Horowitz A, Brennan M, Reinhardt JP, MacMillan T. The impact of assistive device use on disability and depression among older adults with age-related vision impairments. J Gerontology: Soc Sci 2006; 61B S274–80.

[40]  American Academy of Audiology. Untreated hearing loss linked to depression, social isolation in seniors. American Academy of Audiology: Reston, VA; 2009. Available online at: http://www.audiology.org/resources/documentlibrary/Pages/UntreatedHearingLoss.aspx [verified June 2011].

[41]  Mara CM, Wechkin HA, Longstreth WT, Rees TS, Syapin CL. GAtes, hearing loss and antiretroviral therapy in patients infected with HIV-1. Arch Neurol 1997; 54 407–10.

[42]  Fried RG, Gupta MA, Gupta AK. Depression and skin disease. Dermatol Clin 2005; 23 657–64.
Depression and skin disease.Crossref | GoogleScholarGoogle Scholar |

[43]  The Strategies for Management of Antiretroviral Therapy (SMART) Study Group CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med 2006; 355 2283–96.
CD4+ count-guided interruption of antiretroviral treatment.Crossref | GoogleScholarGoogle Scholar |

[44]  Crothers K, Butt AA, Gibert CL, Rodriguez-Barradas MC, Crystal S, Justice AC. Increased COPD among HIV-positive compared to HIV-negative veterans. Chest 2006; 130 1326–33.
Increased COPD among HIV-positive compared to HIV-negative veterans.Crossref | GoogleScholarGoogle Scholar |

[45]  Arnsten JH, Freeman R, Howard AA, Floris-Moore M, Lo J, Klein RS. Decreased bone mineral density and increased fracture risk in aging men with or at risk for HIV infection. AIDS 2007; 21 617–23.
Decreased bone mineral density and increased fracture risk in aging men with or at risk for HIV infection.Crossref | GoogleScholarGoogle Scholar |

[46]  Moreno-Perez O, Escoin C, Serna-Candel C, Pico A, Alfayate R, Merino E, et al Risk factors for sexual and erectile dysfunction in HIV-infected men: the role of protease inhibitors. AIDS 2010; 24 255–64.
Risk factors for sexual and erectile dysfunction in HIV-infected men: the role of protease inhibitors.Crossref | GoogleScholarGoogle Scholar |

[47]  Kantor J, Bilker WB, Glasser DB, Margolis DJ. Prevalence of erectile dysfunction and active depression: an analytic cross-sectional study of general medical patients. Am J Epidemiol 2002; 156 1035–42.
Prevalence of erectile dysfunction and active depression: an analytic cross-sectional study of general medical patients.Crossref | GoogleScholarGoogle Scholar |

[48]  Katon WJ, Lin EHB, Von Korff M, Ciechanowski P, Ludman EJ, Young B, et al Collaborative care for patients with depression and chronic diseases. N Engl J Med 2010; 363 2611–20.
Collaborative care for patients with depression and chronic diseases.Crossref | GoogleScholarGoogle Scholar |

[49]  Karpiak SE, Brennan M. The emerging population of older adults with HIV and introduction to ROAH the research study. In: Brennan M, Karpiak SE, Cantor MH, Shippy RA, editors. Research on older adults with HIV: an in-depth examination of an emerging population. New York: Nova Science; 2009. pp. 1–12.

[50]  Brennan M, Applebaum A. Loneliness among older adults with HIV. In: Brennan M, Karpiak SE, Cantor MH, Shippy RA, editors. Research on older adults with HIV: an in-depth examination of an emerging population. New York: Nova Science; 2009. pp. 75–78.

[51]  Cantor MH, Brennan M, Karpiak SE. The social support networks of older people with HIV. In: Brennan M, Karpiak SE, Cantor MH, Shippy RA, editors. Research on older adults with HIV: an in-depth examination of an emerging population. New York: Nova Science; 2009. pp. 61–74.

[52]  Brennan M, Karpiak SE. HIV stigma and disclosure of serostatus. In: Brennan M, Karpiak SE, Cantor MH, Shippy RA, editors. Research on older adults with HIV: an in-depth examination of an emerging population. New York: Nova Science; 2009. pp. 51–60.

[53]  Moore RD. Epidemiology of HIV infection in the United States: implications for linkage to care. Clin Infect Dis 2011; 52 S208–13.
Epidemiology of HIV infection in the United States: implications for linkage to care.Crossref | GoogleScholarGoogle Scholar |

[54]  Sosman J. M. HIV care: Policy implications. Am J Managed Care 2010; 16 S339–44.