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Depressive Symptoms, Neurocognitive Impairment, and Adherence to Highly Active Antiretroviral Therapy Among HIV-Infected Persons

Received March 21, 2003; revision received Sept. 12, 2003; accepted Oct. 17, 2003. From Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Rome; Istituto Nazionale per le Malattie Infettive, Lazzaro Spallanzani Istituto di Ricovero e Cura a Caratterre Scientifico, Rome; Servizio Psichiatria di Consultazione ed Epidemiologia Comportamentale, Ospedale Domenico Cotugno, Naples; Istituto di Malattie Infettive e Tropicali, Università di Milano, Milan; and the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore. Address reprint requests to Dr. Ammassari, Department of Infectious Diseases, Catholic University, L.go A. Gemelli 8, 00168 Rome, Italy; aammassari{at}libero.it (e-mail).

The association of depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy (HAART) was evaluated in 135 HIV-infected persons. Thirty percent reported nonadherence to HAART. Depressive symptoms (assessed with the Montgomery-Åsberg Depression Rating Scale) and neurocognitive impairment (assessed with a neuropsychological test battery) were documented in 24% and 12%, respectively, of the study participants. Nonadherence to HAART was independently associated with worse depression rating scale scores (odds ratio=1.05, 95% confidence interval [CI]=1.00–1.10), acquisition of HIV through injection of drugs (odds ratio=2.59, 95% CI=1.05–6.39), and complaints about impairment of sexual activity (odds ratio=6.62, 95% CI=1.16–37.6). The presence of depressive symptoms, but not neurocognitive impairment, was associated with nonadherence.

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