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Kaiser Permanente -- Group Health study shows depression worsens HIV treatment

December 20, 2007

December 20, 2007 (Oakland, Calif.) - The largest study to examine the effect of depression on HIV treatment found that depression significantly worsens a patient's adherence to highly active antiretroviral therapy and clinical measures, but that effective antidepressant medication can reverse this outcome, according to a study by the Kaiser Permanente Division of Research and the Group Health Cooperative published in the current online issue of the Journal of Acquired Immune Deficiency Syndromes (JAIDS).

The study looked at 3,359 HIV-infected patients from seven Kaiser Permanente regions nationwide and Group Health in 2000 to 2003 to measure the effects of depression -- with and without selective serotonin reuptake inhibitors (SSRI) use -- on adherence and changes in viral and immunologic control in patients starting a new highly active antiretroviral therapy (HAART) regimen.

The researchers studied the patients' HAART adherence, viral loads, and changes in CD4 T-cell counts over a 12-month period. The study found that depressed patients -- 42 percent of the patient group -- had a lower adherence rate and worse viral therapy response compared to non-depressed patients. But depressed patients who were prescribed SSRI medication and adhered to it had the same outcomes as non-depressed patients.

"The take-home point of this study is that depression carries a worse prognosis for HAART in HIV patients. However, we also found that SSRIs can reverse this and improve outcomes for HIV-depressed patients," said Michael A. Horberg, MD, MAS, FACP, Director of HIV/AIDS for Kaiser Permanente and the lead author on the study. "HIV and depression often go hand in hand. If you are HIV-infected, you should be screened regularly for depression, and if you are depressed and you are going to go on HAART, it's very worthwhile to treat your depression."
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Kaiser Permanente and Group Health are the second largest provider of HIV care in the United States, caring for more than 17,000 patients annually. Recent quality performance analysis show that Kaiser Permanente and Group Health HIV patients have a very high rate of adhering to their medicine, strong viral control and good responses to therapy.

Co-authors on the study included Kaiser Permanente's Michael Silverberg, PhD, MPH, Leo Hurley, MPH, William Towner, MD, Daniel Klein, MD, Susan Bersoff-Matcha, MD, Winkler Weinberg, MD, Diana Antoniskis, MD, Miguel Mogyoros, MD, Robert Dobrinich, MD, Charles Quesenberry, PhD, and Drew Anthony Kovach, MD, and Wayne Dodge, MD, of Group Health.

About Kaiser Permanente

Kaiser Permanente is America's leading integrated health plan. Founded in 1945, it is a not-for-profit; group practice program headquartered in Oakland, Calif. Kaiser Permanente serves 8.7 million members in nine states and the District of Columbia. Today it encompasses the not-for-profit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 156,000 technical, administrative and clerical employees and caregivers, and 13,000 physicians representing all specialties. For more information about Kaiser Permanente, visit the Kaiser Permanente News Center at: http://xnet.kp.org/newscenter

About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well being and to improve the quality and cost-effectiveness of health care. Currently, the center's 400-plus staff is working on more than 250 epidemiological and health services research projects.
www.kaiserpermanente.org

Contact:

Danielle Cass, Kaiser Permanente National Media Relations
Danielle.X.Cass@kp.org or (510) 267-5354 office / (510) 205 9622 cell

Maureen McInaney-Jones, Kaiser Permanente Division of Research
Maureen.mcinaney@kp.org or (510) 891-3173

Kaiser Permanente

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