Inside out: TNFa-RII and sexualized drug use in acute HIV predicts persistent depressive symptoms despite antiretroviral therapy.

OBJECTIVE

Although pathophysiologic alterations during acute HIV infection (AHI) may have long-term neuropsychiatric consequences, scant research has examined biobehavioral predictors of distinct depressive symptom trajectories from AHI through suppressive anti-retroviral therapy (ART), despite the fact that depressive symptoms have been associated with poorer adherence to ART and overall quality of life.

METHODS

This analysis utilized data from the RV254/SEARCH010 Cohort, a large, well-characterized AHI cohort in Bangkok, Thailand. Longitudinal hierarchal density-based spatial clustering with uniform manifold approximation and projection was used to examine depressive symptom trajectories from AHI through 96 weeks of suppressive ART. Logistic regressions examined the immunologic and behavioral correlates of persistently high (versus low) depressive symptom trajectories.

RESULTS

Participants (N = 502) were between the ages of 18 and 70, with a mean age of 27.7 (SD 7.4). The sample was predominantly male (98 %, n = 494). Three depressive symptom trajectories emerged: Cluster 1 (n = 257, 51 %) persistently high, Cluster 2 (n = 61, 12 %) transient, and Cluster 3 (n = 184, 37 %) persistently low. There were greater odds of persistently high (versus low) depressive symptoms for every log10copies/mL increase in plasma viral load (Odds Ratio [OR] = 1.27; 95 % Confidence Interval [CI] = 0.99-3.35) and sTNF-αRII (OR = 1.23, 95 % CI = 1.04, 1.45) at baseline. Recent amyl nitrite use also increased risk (OR = 2.39; 95 % CI = 1.17, 4.88).

CONCLUSIONS

Viral load, inflammation and substance use may be viable targets for reducing risk for depressive disorders in people with HIV, even in its earliest stages.