Funding Source and Period: HIV Center Pilot Studies Program; 2007-2008

Key HIV Center Personnel:

HIV Center Fellow: Mark Bradley, M.D.
Mentor: Robert Remien, Ph.D.

Project Overview
(from abstract of research plan)

Antiretroviral adherence is critical to virologic suppression, successful HIV treatment outcomes, and the prevention of drug-resistant virus strains. Although many studies have identified depression as a major predictor of antiretroviral nonadherence, no studies to date have prospectively examined the effect of depression symptom reduction over time on antiretroviral adherence in depressed, nonadherent HIV+ patients. As described in this revision to a previously submitted pilot proposal, this study would begin to address such gaps in our knowledge by estimating effect sizes and examining feasibility issues in order to lay the groundwork for a future, larger-scale study of depression treatment and adherence.

This study will employ a naturalistic design to follow HIV medication adherence changes over time in depressed HIV+ patients who have just started antidepressant therapy. 30 HIV+ patients who have been identified as depressed and nonadherent will be enrolled and followed for 16 weeks. Depression symptoms, self-report adherence data, and substance use measures will be collected at baseline and at 4, 8, 12, and 16 weeks. We will also abstract pre- and post- study patient viral loads from chart records. Data analysis will examine how adherence changes over time in relation to changes in depression symptoms. This study will lay the groundwork for future research and larger studies examining how treatment for depression, and for other serious mental illness, may be employed as means to improve HIV medication adherence, and improve medical outcomes in HIV disease.