HIV PrEP Doesn't Increase Depression Risk

June 23, 2015
Meghan Ross, Associate Editor

Pharmacists can reassure patients taking pre-exposure prophylaxis that the human immunodeficiency virus prevention treatment will not increase their risk for depression.

Pharmacists can reassure patients taking pre-exposure prophylaxis (PrEP) that the human immunodeficiency virus (HIV) prevention treatment will not increase their risk for depression.

“Because previous studies suggested a link between certain antiretroviral therapies and depression, we wanted to explore whether or not there was an increased risk for psychosocial health problems associated with PrEP,” said study author Robert Grant, MD, MPH, a senior investigator at the Gladstone Institutes, in a press release. Dr. Grant and his research team randomized men and transgender women who have sex with men to take either placebo or Gilead’s emtricitabine and tenofovir disoproxil fumarate (Truvada) for PrEP daily.

The purpose of the study was to determine whether the PrEP group displayed more depressive symptoms than the placebo group. While depression-related symptoms were the most commonly reported adverse events, the rate was not significantly higher in the PrEP arm compared with the placebo one. Scores on the Center for Epidemiologic Studies Depression (CES-D) rating system and a suicidal ideation scale were also similar for both groups.

Those who reported experiencing forced sex had higher CES-D scores and were more likely to have suicidal thoughts. CES-D scores were also higher among those who reported not using condoms during sexual intercourse.

“Depressive symptoms are associated with sexual practices that increase risk for HIV acquisition,” said study author Patricia Defechereux, PhD, a senior research associate at the Gladstone Institutes, in a press release.

“The additional protection conferred by PrEP during episodes of depression could avert infections during these especially vulnerable times.” Overall, half of the participants in both groups had depression scores that would classify them as clinically depressed.

“We recommend continuing PrEP during periods of depression in conjunction with provision of mental health services,” concluded the authors of the study, which was published in AIDS and Behavior. A previous study found that health care providers generally favor PrEP for patients at high risk of acquiring HIV, though many hesitate to actually prescribe it, citing concerns about treatment adherence, follow-up care for monitoring and counseling, and drug effectiveness.

Consistent PrEP use can lower the risk of HIV infection by 92% among those at high risk for transmission, according to the US Centers for Disease Control and Prevention.