Treating Depression in HIV

Evidence-based treatment for depression and adherence counseling could boost HIV treatment.

Patients who are depressed and who have HIV could benefit from evidence-based treatment for depression and adherence counseling, according to recent research. The study was conducted by Steven Safren, PhD, of the Department of Psychology at the University of Miami and colleagues, and was published in The Lancet HIV on September 19, 2016.

Depression and poor adherence to antiretroviral therapy (ART) go hand-in-hand. “Integrating cognitive behavioral therapy (CBT) for depression with adherence counseling using the Life-Steps approach (CBT-AD) has an emerging evidence base,” say the researchers, adding that their aim with this study was to test the efficiency of that combination.

The study was designed as a three-arm randomized controlled trial. Participants were drawn from three centers in New England and were randomly assigned to a CBT-AD group, an information and supportive therapy group plus adherence counseling (ISP-AD) group, or an enhanced treatment as usual (ETAU) group which received only adherence counseling.

A total of 83 participants in the CBT-AD group completed the full assessment, as did 87 from the ISP-AD group, and 46 from the ETAU group. “The primary outcome was ART adherence at the end of treatment (4 month assessment) assessed via electronic pill caps (Medication Event Monitoring System [MEMS]) with correction for pocketed doses, analyzed by intention to treat,” say the researchers.

There were no adverse events during the course of the study, and there were no significant differences between those in the CBT-AD group and the ISP-AD group. However, those in the ETAU group had less improvement in both adherence and depression scores. The researchers say, “Future efforts should examine how to best disseminate effective psychosocial depression treatments such as CBT-AD to people living with HIV/AIDS and examine the cost-effectiveness of such approaches.”