Association Between Alcohol Use, CD4 Count, and Depressive Symptoms Among People with HIV with Viral Load Suppressed in Southwestern Uganda.

Despite the current effective antiretroviral therapy (ART) and viral suppression, depression remains the most prevalent mental health challenge among people with HIV (PWH) in Uganda and worldwide. This study examined the relationship between CD4 cell count and depressive symptoms among PWH on ART with viral suppression, and the potential modification effect of alcohol use on this relationship. We combined baseline data from two longitudinal studies (DIPT (NCT03492216) and ADEPTT (NCT03302299)) conducted between May 2017 and August 2021 across four health facilities in Southwestern Uganda. Eligible participants were adults with suppressed HIV viral load. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CESD) Scale (≥ 16 considered significant). CD4 + count was measured through blood tests, while alcohol use was measured using both the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) and the alcohol biomarker phosphatidylethanol (PEth), measured in dried blood spots. Multivariable mixed effects logistic regression models examined associations. Among 908 participants, 14.6% had depressive symptoms. The median CD4 count was 632 cells/mm³ (IQR: 467.5-825.5), and 62.1% had high or very high-risk alcohol use. Overall, no significant association was found between CD4 count and depressive symptoms (aOR: 1.04; 95% CI: 0.97-1.12; p = 0.26). Additionally, no evidence of effect modification by level of alcohol use (p = 0.10) was found. The prevalence of depressive symptoms is high among PWH with viral suppression. Healthcare providers should assess and manage depression among this population. Further studies should also explore the causes of the depressive symptoms and develop targeted interventions.