The effect of sertraline on depression and associations with persistent depression in survivors of HIV-related cryptococcal meningitis

• Published in: Wellcome open research Vol. 6; p. 45
• Main Authors: Lofgren, Sarah M., Velamakanni, Sruti S., Huppler Hullsiek, Katherine, Bangdiwala, Ananta S., Namudde, Alice, Musubire, Abdu K., Mpoza, Edward, Abassi, Mahsa, Pastick, Katelyn A., Nuwagira, Edwin, Evans, Emily E., Rajsasingham, Radha, Williams, Darlisha A., Muzoora, Conrad, Creswell, Fiona V., Rhein, Joshua, Bond, David J., Nakasujja, Noeline, Meya, David B., Boulware, David R.
• Format: Journal Article
• Language: English
• Published: 2021
• ISSN: 2398-502X; 2398-502X
• DOI: 10.12688/wellcomeopenres.16363.1

Background : Depression is a risk factor for worse outcomes in persons living with HIV/AIDS and has a prevalence more than three times as high as in the general population. Despite this, there are few randomized studies of antidepressants in HIV-infected Africans. Methods: We enrolled 460 HIV-infected Africans with cryptococcal meningitis into a randomized clinical trial of adjunctive sertraline vs placebo (2015-2017). We defined depression using depression using a Center for Epidemiologic Studies Depression Scale (CES-D) score of >15, and severe depression as >26 at one and three months after meningitis diagnosis and initiation of treatment.We evaluated the relationship between sertraline and depression, as well as associations with persistent depression, at three months. Results: At one- and three-months post meningitis diagnosis, 62% (108/174) and 44% (74/169) of all subjects had depression (CES>15), respectively. At three months, sertraline-treated subjects had consistent risk for depression as placebo-treated subjects but were significantly less likely to have severe depression (CES>26) (OR 0.335; 95%CI, 0.130-0.865). Of those with depression at one month, sertraline-treated subjects were less likely than placebo-treated subjects to be depressed at three months (p=0.05). Sertraline was the only factor we found significant in predicting persistent depression at three months among those who had depression at one month. Conclusions: Depression is highly prevalent in HIV-infected persons who have survived cryptococcal meningitis. We found that sertraline is associated with a modest reduction in depression in those with depression at baseline and a significant decrease in severe depression.