by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

January 16, 2024

Featured Literature:

Parra-Rodriguez L, O’Halloran J, Wang Y, et al.  Common antiretroviral combinations are associated with somatic depressive symptoms in women with HIV.  AIDS.  2024 Feb 1;38(2):167-176.  doi: 10.1097/QAD.0000000000003730.  PMID: 37773048. 

This study examined the longitudinal relationships between commonly used ART regimens and frequency of somatic and cognitive/affective (non-somatic) depressive symptoms in WIHS participants.  Inclusion criteria were three or more visits, stable ART status, and available information from the Center for Epidemiological Studies Depression scale (a 20-item self-administered tool measuring symptom frequency over the previous week).  From January 2014 to September 2016, 12,924 observations from 1,538 participants were included in the final analysis.  At baseline, mean age was 49.9 years, and 72% identified as Black and 14% as Hispanic.  Based on frequency of positive depression screening, 30% of participants were classified into the chronic depression group (Group 1), 33% in the infrequent depression group (Group 2), and 37% as never depressed (Group 3).  Across all visits, common ART regimens (the three most common combinations being EFV/F/TDF, DTG/ABC/3TC, and RPV/F/TDF) were significantly associated with somatic depressive symptoms in Group 1 but not the other groups.  In Group 1, combinations including TAF plus cobicistat-boosted EVG and/or DRV were associated with more somatic symptoms after adjusting for pre-specified covariates and accumulative exposure time of all individual ARVs.  No associations were observed with similar regimens containing TDF, or DTG- or BIC-containing regimens.

Author’s Commentary:

This study affirms the complex nature of ART and depressive symptoms: among WIHS participants with positive depression screening results across ≥ 50% of study visits, certain ARV combinations were linked to more somatic depression symptoms, i.e., unpleasant or worrisome bodily sensations including sleep, appetite, and concentration changes.  In contrast, non-somatic symptoms did not appear to have any significant association.  Potential ART-specific mechanisms underlying these observations is largely unknown, and some results from this cohort differ from those of other studies (although study populations were distinct).  These findings, among others, provide compelling reason to continue exploring neuropsychiatric side effects of antiretroviral agents to better understand their impact on behavioral health, especially for populations with high prevalence of chronic mental health conditions and traumas. 

View archived Clinical Research Update entries here.