BackgroundDepression is highly prevalent among people living with HIV (PLWH). However, few studies have examined its relationship with clinical and nutritional outcomes in sub-Saharan Africa.MethodsWe conducted a cohort study of 3996 PLWH in Tanzania. Depressive symptoms were measured at antiretroviral therapy (ART) initiation with the Hopkins Symptom Checklist-25 (HSCL-25). Symptoms consistent with depression were defined using the conventional HSCL-25 (score >1.75) and Tanzania-adapted (score >1.06) cutoffs. We evaluated the association of depression defined by both cut-offs and tertiles of HSCL-25 scores with clinical and nutritional outcomes using regression models.ResultsUsing the conventional HSCL-25 cutoff, men with symptoms consistent with depression had increased risk of all-cause mortality (hazard ratio (HR): 1.68; 95% CI: 1.17-2.39) and HIV disease progression (HR: 1.59; 95% CI: 1.15-2.19). Women in the highest tertile of depressive symptom scores had increased risk of >10% weight loss (HR: 1.27; 1.05-1.55) and incident pulmonary TB (HR: 1.93, 95% CI: 1.19-3.12).ConclusionsDepressive symptoms at ART initiation were associated with poor clinical and nutritional outcomes; however, the risks appear to differ by gender and depression severity.
Khimani et al. (Thu,) studied this question.