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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Poor CD4 count is a predictor of untreated depression in human immunodeficiency virus-positive African-Americans
Sasraku Amanor-Boadu, MariaMananita S Hipolito, Narayan Rai, Charlee K McLean, Kyla Flanagan, Flora T Hamilton, Valerie Oji, Sharon F Lambert, Huynh Nhu Le, Suad Kapetanovic, Evaristus A Nwulia
Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States
MariaMananita S Hipolito, Narayan Rai, Charlee K McLean, Evaristus A Nwulia, Department of Psychiatry and Behavioral Sciences, Translational Neuroscience Laboratory, Howard University, Washington, DC 20060, United States
Kyla Flanagan, Flora T Hamilton, Family and Medical Counseling Service, Inc., Washington, DC 20020, United States
Valerie Oji, Lifefountain Center Ministries, Inc., Katy, TX 77450, United States
Sharon F Lambert, Huynh-Nhu Le, Department of Psychology, George Washington University, Washington, DC 20052, United States
Suad Kapetanovic, National Institutes of Health, National Institute of Mental Health, Bethesda, MD 20892, United States
Author contributions: Amanor-Boadu S and Nwulia EA contributed equally to this work; Hipolito MS, Rai N and McLean CK collected and analyzed the data, and drafted the manuscript; Kapetanovic S and Nwulia EA provided analytical oversight; Nwulia EA designed and supervised the study; Amanor-Boadu S, Kapetanovic S and Nwulia EA revised the manuscript for important intellectual content; Rai N, McLean CK and Flanagan K offered the technical or material support; Hipolito MS, Rai N and McLean CK provided administrative support; all authors have read and approved the final version to be published.
Supported by In whole with Federal funds from the National Cancer Institute, National Institutes of Health, under Contract, No. HHSN261200800001E.
Institutional review board statement: The study was reviewed and approved by the Howard Institutional Review Board.
Informed consent statement: Data collected for the HU IRB approved study has no identifiable information that will link the data to a person.
Conflict-of-interest statement: The content of this publication does not necessarily reflect the views of policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the United States Government.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at enwulia@howard.edu. Consent was not obtained but the presented data are anonymized and risk of identification is nil.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Evaristus A Nwulia, MD, MHS, Associate Professor of Psychiatry Howard University, Department of Psychiatry and Behavioral Sciences, Translational Neuroscience Laboratory, Howard University, 2041 Georgia Ave., NW, 5
th Floor, Washington, DC 20060, United States.
enwulia@howard.edu
Telephone: +1-202-8651742 Fax: +1-202-8653068
Received: June 26, 2015
Peer-review started: July 9, 2015
First decision: September 30, 2015
Revised: December 5, 2015
Accepted: December 18, 2015
Article in press: December 21, 2015
Published online: March 22, 2016
Processing time: 264 Days and 4.6 Hours
AIM: To determine if efforts to improve antiretroviral therapy (ART) adherence minimizes the negative impact of depression on human immunodeficiency virus (HIV) outcomes.
METHODS: A cross-sectional study of a clinic-based cohort of 158 HIV seropositive (HIV+) African Americans screened for major depressive disorder (MDD) in 2012. CD4 T lymphocyte (CD4+) counts were obtained from these individuals. Self-report on adherence to ART was determined from questionnaire administered during clinic visits. The primary outcome measure was conditional odds of having a poorer CD4+ count (< 350 cells/mm3). Association between CD4+ count and antidepressant-treated or untreated MDD subjects was examined controlling for self-reported adherence and other potential confounders.
RESULTS: Out of 147 individuals with available CD4+ T lymphocyte data, 31% hadCD4+ count < 350 cells/mm3 and 28% reported poor ART adherence. As expected the group with > 350 cells/mm3 CD4+ T lymphocyte endorsed significantly greater ART adherence compared to the group with < 350 cells/mm3 CD4+ T lymphocyte count (P < 0.004). Prevalence of MDD was 39.5% and 66% of individuals with MDD took antidepressants. Poor CD4+ T lymphocyte count was associated with poor ART adherence and MDD. Adjusting for ART adherence, age, sex and education, which were potential confounders, the association between MDD and poor CD4+ T lymphocyte remained significant only in the untreated MDD group.
CONCLUSION: Therefore, CD4+ count could be a clinical marker of untreated depression in HIV+. Also, mental health care may be relevant to primary care of HIV+ patients.
Core tip: A retrospective data review was done on human immunodeficiency virus+ patients of a primary care clinic. We examined data on depression diagnosis of patients over a two-year period. Antiretroviral therapy (ART) adherence and major depressive disorder were associated with CD4+ lymphocyte counts. Non-treatment of depression was associated with poor CD4+ lymphocyte count independent of ART adherence.
