Association Between Race, Depression, and Antiretroviral Therapy Adherence in a Low-Income Population with HIV Infection

• Published in: Journal of general internal medicine : JGIM Vol. 27; no. 9; pp. 1159 - 1164
• Main Authors: Kong, Meg C., Nahata, Milap C., Lacombe, Veronique A., Seiber, Eric E., Balkrishnan, Rajesh
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.09.2012; Springer; Springer Nature B.V
• Subjects: Adult; Adult and adolescent clinical studies; Anti-Retroviral Agents - economics; Anti-Retroviral Agents - therapeutic use; Antidepressive Agents - economics; Antidepressive Agents - therapeutic use; Antiretroviral drugs; Antiretroviral Therapy, Highly Active - economics; Biological and medical sciences; Cohort Studies; Compliance; Continental Population Groups - ethnology; Depression; Depression - drug therapy; Depression - economics; Depression - ethnology; Drug therapy; Female; General aspects; HIV; HIV Infections - drug therapy; HIV Infections - economics; HIV Infections - ethnology; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Internal Medicine; Male; Medicaid; Medical sciences; Medication Adherence - ethnology; Medicine; Medicine & Public Health; Mental depression; Middle Aged; Mood disorders; Original Research; Poverty - economics; Poverty - ethnology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Racial differences; Retrospective Studies; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; depression; HIV; race; Medicaid; adherence; Antiretroviral agent; Socioeconomic status; Income; Drug compliance; Association; Race; Antiviral; Treatment compliance; Population; Public health; Mood disorder; Human; Immunopathology; Ethnic origin; Personal income; Retroviridae; Depression; AIDS; Immune deficiency; Lentivirus; Adhesion; Infection; Virus; Chemotherapy; Treatment; Viral disease; Human immunodeficiency virus
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-012-2043-3

Background Racial disparities exist in many aspects of HIV/AIDS. Comorbid depression adds to the complexity of disease management. However, prior research does not clearly show an association between race and antiretroviral therapy (ART) adherence, or depression and adherence. It is also not known whether the co-existence of depression modifies any racial differences that may exist. Objective To examine racial differences in ART adherence and whether the presence of comorbid depression moderates these differences among Medicaid-enrolled HIV-infected patients. Design Retrospective cohort study. Setting Multi-state Medicaid database (Thomson Reuters MarketScan®). Participants Data for 7,034 HIV-infected patients with at least two months of antiretroviral drug claims between 2003 and 2007 were assessed. Main Measures Antiretroviral therapy adherence (90 % days covered) were measured for a 12-month period. The main independent variables of interest were race and depression. Other covariates included patient variables, clinical variables (comorbidity and disease severity), and therapy-related variables. Key Results In this study sample, over 66 % of patients were of black race, and almost 50 % experienced depression during the study period. A significantly higher portion of non-black patients were able to achieve optimal adherence (≥90 %) compared to black patients (38.6 % vs. 28.7 %, p < 0.001). In fact, black patients had nearly 30 % decreased odds of being optimally adherent to antiretroviral drugs compared to non-black patients (OR = 0.70, 95 % CI: 0.63–0.78), and was unchanged regard less of whether the patient had depression. Antidepressant treatment nearly doubled the odds of optimal ART adherence among patients with depression (OR = 1.92, 95 % CI: 1.12–3.29). Conclusions Black race was significantly associated with worse ART adherence, which was not modified by the presence of depression. Under-diagnosis and under-treatment of depression may hinder ART adherence among HIV-infected patients of all races.