Antidepressant Treatment of Depression in HIV-Seropositive Women

Background: This study aimed to assess the effectiveness of fluoxetine and sertraline in treating depressed women who are seropositive for the human immunodeficiency virus (HIV) and to document barriers to study participation.

Method: Ambulatory HIV-seropositive women with DSM-IV depressive disorders were enrolled in an 8-week, open trial of fluoxetine (N = 21) or sertraline (N = 9) initiated at standard dosages. Outcome measures included the Clinical Global Impressions-Improvement scale (CGI), Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), physical function ratings, and CD4 count.

Results: Thirty-six women were screened for the study and 30 were enrolled. Mean age was 35.5 years and HIV risk was primarily intravenous drug use (N = 16; 53%) or heterosexual contact (N = 12; 40%). Sixteen (53%) were Hispanic, 11 (37%) were African American, and 3 (10%) were white. Mean ± SD CD4 count was 463 ± 312 cells/μL, and 30% had acquired immunodeficiency syndrome (AIDS). Eighteen women (60%) completed the trial (14 fluoxetine: dose range, 10-40 mg/day; 4 sertraline: dose range, 25-100 mg/day). Of completers, 14 (78%) were clinical responders by CGI and reduction in HAM-D > 50%. Statistically significant reductions were seen in HAM-D and BDI scores, but not in measures of physical function or CD4 count. The most frequent adverse effects were anxiety, overstimulation, and insomnia. Reasons for nonparticipation or dropout included refusal to accept antidepressants on account of negative bias, preferring psychotherapy alone, adverse effects, and relapse to illicit drugs.

Conclusion: While HIV-seropositive women may benefit from antidepressant treatment, multiple barriers to successful treatment exist. Aggressive outreach, education, and attention to the complex psychosocial needs of HIV-seropositive women are essential components of depression treatment in this population.