Resumen
Background: Depression is common in HIV-infected patients. It has been mostly studied the relationship between depressive symtoms and antiretroviral therapy (ART). However, depression hasn’t been enough studied in relation to comorbidities, other geriatric syndromes and variables related to HIV infection different than ART in HIV-infected patients. Objectives: to determine the prevalence of depressive symtoms in older HIV-infected adults and to describe factors related to depression. Methods: Cross-sectional study. Between June 2014 and June 2015, consecutive patients >55 years seen at the HIV clinics of two public university hospitals in Madrid were included in the study. We used the Geriatric Depression Scale Short Form (SF-GDS) to evaluate depression. We recorded sociodemographic data, comorbidities (Cumulative Illness Rating Scale (CIRS)), medications, and variables related to HIV infection. We recorded data on physical status using the Short Physical Performance Batery (SPPB) and the Short-Form Late-Life Function and Disability Instrument (SF-LLFDI). We also recorded data on frailty (The Fried Frailty criteria), nutritional, mental, and social status using a comprehensive geriatric assessment. Results: We evaluated 117 HIV-infected patients. Mean age was 61.3 ([CI] 55-81) years. All patients were under ART. All but one patients were undetectable HIV RNA. The prevalence of depressive symtoms defined as SF-GDS score > 6 was 24.8%. In the univariate analysis, depressive symtoms were found to be associated with primary education (p=0.03), risk practice for HIV-infection other than MSM (p=0.02), more than 10 years living with HIV (p=0.01), CD4/CD8 rate (p=0.05), CIRS severity (p=0.008), being smoker (p=0.009), osteoarticular disease (p=0.03), SF-LLFDI (p=0.03), SPPB score< 8 (p=0.007) and frailty (p=0.002). No association was found with: age, gender, CD4 nadir, HCV coinfection, other individual comorbidities, polypharmacy, cognitive impairment measured with MMSE test or nutritional state measured with MNA-SF test. The multivariate analysis revealed that only primary education (OR [95%CI], 5.77 [1.48-22.5]) and being smoker (OR [95%CI], 4.67[1.33-16.36]) increased the risk of depression while more than 10 years living with HIV (OR [95%CI], 0.1[0.015-0.68]) and higher SF-LLFDI scores, which means better functional status, (OR [95%CI], 0.92[0.87-0.98]) protected against depression. Conclusions: Smoker patients and those with only primary education among HIV-infected older adults are at risk of depression, specially in their first years after HIV infection diagnosis. Having a good functional status is protective against depression. So, depression screening should be considered in the early years after HIV-infection diagnosis in this group in order to design strategies to quit smoking and to improve their functional status.
Autoría:
BRAÑAS BATZÁN, Fátima;
RAMÍREZ, M.;
DRONDA, Fernando;
LÓPEZ BERNALDO DE QUIRÓS, Juan Carlos;
PÉREZ ELÍAS, María Jesús;
MIRALLES, P.;
MORENO, A.;
BERENGUER, J.;
MORENO, S.;
SÁNCHEZ CONDE, Matilde
Autoría institucional:
Hospital Universitario Ramón y Cajal