Jim Kling

September 20, 2013

DENVER — In patients with HIV, detectable virus in cerebrospinal fluid (CSF) is more prevalent in those with major depressive disorder, according to a new study.

"We believe that some inherent conditions that are associated with HIV may also be associated with depression," said study author Edward Hammond, MD, a doctoral student at Johns Hopkins University in Baltimore. "One would be the inflammatory component, and depression, like HIV, is an inflammatory state."

The research, presented here at the 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy, evaluates the association between major depression and viral escape in people on antiretroviral therapy with undetectable plasma viral loads.

To assess this association, Dr. Hammond's team conducted a prospective study of the 6-center CNS HIV Antiretroviral Therapy Effects Research (CHARTER) cohort. The researchers followed 212 patients without CSF viral escape at study entry; they underwent a minimum of 3 CSF examinations over 2736 person-months.

"We found that if you don't have depression and you have virus in your brain, you get depressed. If you don't have virus in your brain and you're depressed, you get viral escape. In either case, we think depression is associated with ongoing central nervous system inflammation," study coauthor Glenn Treisman, MD, director of the AIDS psychiatry service at Johns Hopkins Medicine, told Medscape Medical News.

In the study cohort, the average age was 43.9 years, 80.6% of the 803 participants were male, 40.9% were white, 46.2% were black, and 13.0% were Hispanic or another race.

At study entry, the overall prevalence of CSF viral escape was 17.6% (n = 141), but the prevalence was higher in patients with major depression than in those without (25.7% vs 16.3%; P = .016).

Over the 18-month study period, the overall cumulative incidence of CSF viral escape in the study population was 15.1%; in those with major depression, it was 26.1%.

We believe that some inherent conditions that are associated with HIV may also be associated with depression.

When risky behavior and medication adherence, which can be a problem in depressed patients, were controlled for, the risk for CSF viral escape was about 3 times higher in people with major depression than in those without (adjusted hazard ratio, 3.01; 95% confidence interval, 1.03 - 8.78; P = .043).

The study has revealed yet another reason to treat depression in HIV patients, aside from decreasing risk behaviors and increasing adherence to medicine, he noted.

"We have to be aware that CSF viral escape occurs much more often than we thought, at a prevalence of about 18%," said Dr. Hammond.

There has always been debate about how common CSF viral escape is. "It may be more common than we realize, and one of the big controversies is whether CSF penetration matters clinically. It's been very hard to prove that. We don't have it correlated with much of anything but depression," said Joel Gallant, MD, associate medical director of specialty services at Southwest Care Center in Santa Fe, New Mexico, who attended the presentation.

Still, the research is interesting and potentially informative. "A lot of us think that depression is a surrogate marker for central nervous system inflammation — not in HIV, but in hepatitis C, multiple sclerosis, in all kinds of conditions," Dr. Gallant told Medscape Medical News. "If it is a surrogate marker for inflammation in HIV, maybe depression would be a good predictor downstream of cognitive impairment."

Dr. Hammond, Dr. Treisman, and Dr. Gallant have disclosed no relevant financial relationships.

53rd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC): Abstract H-1257a. Presented September 12, 2013.


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