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Untreated depression among persons living with human immunodeficiency virus in Kazakhstan: A cross-sectional study.

Untreated depression among persons living with human immunodeficiency virus in Kazakhstan: A cross-sectional study.
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Terloyeva D, Nugmanova Z, Akhmetova G, Akanov A, Patel N, Lazariu V, Norelli L, McNutt LA,


Terloyeva D, Nugmanova Z, Akhmetova G, Akanov A, Patel N, Lazariu V, Norelli L, McNutt LA, (click to view)

Terloyeva D, Nugmanova Z, Akhmetova G, Akanov A, Patel N, Lazariu V, Norelli L, McNutt LA,

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PloS one 2018 03 2813(3) e0193976 doi 10.1371/journal.pone.0193976

Abstract
BACKGROUND
In Kazakhstan, scarce official prevalence data exists for mood disorders. This study investigates the occurrence of depressive symptoms among people living with HIV/AIDS (PLWHA), and the relationship between depressive symptoms, HIV treatment initiation and antiretroviral treatment (ART) adherence.

METHODS
A cross-sectional study was conducted among patients seen at the Almaty AIDS Center between April and December 2013. Two data sources were used: 1) self-administered survey that included the Patient Health Questionnaire (PHQ-9) to capture depression symptoms and 2) medical record review. Two primary outcomes were evaluated with log-binomial models and Fisher’s exact test: the relationship between depression symptoms and 1) HIV treatment group, and 2) HIV adherence.

RESULTS
Of the 564 participants, 9.9% reported symptoms consistent with a depressive disorder. None had received treatment for depression. Among those not on ART, a relationship between depressive symptoms and low CD4 counts (≤ 350 cells/mm3) was evident (7.1% for CD4 ≤ 350 cells/mm3 vs. 0.9% for CD4 > 350 cells/mm3, p = 0.029). In multivariable analysis, a higher prevalence of depressive symptoms was statistically associated with ART treatment, positive hepatitis C virus (HCV) status, and being unmarried. For those taking ART, treatment adherence was not statistically associated with a lower prevalence of depressive symptoms (12.5% vs 20.0%, p = 0.176); limited power may have impacted statistical significance.

CONCLUSIONS
Untreated depression was found among PLWHA suggesting the need to evaluate access to psychiatric treatment. A collaborative strategy may be helpful to optimize HIV treatment outcomes.

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