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AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV a
a
b
a
a
Sangini S. Sheth , Jenell Coleman , Tirza Cannon , Lorraine Milio , Jean Keller , Jean a
Anderson & Cynthia Argani
a
a
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA b
Click for updates
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA Published online: 23 Jan 2015.
To cite this article: Sangini S. Sheth, Jenell Coleman, Tirza Cannon, Lorraine Milio, Jean Keller, Jean Anderson & Cynthia Argani (2015) Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 27:3, 350-354, DOI: 10.1080/09540121.2014.998610 To link to this article: http://dx.doi.org/10.1080/09540121.2014.998610
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
AIDS Care, 2015 Vol. 27, No. 3, 350–354, http://dx.doi.org/10.1080/09540121.2014.998610
Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV Sangini S. Shetha*, Jenell Colemana, Tirza Cannonb, Lorraine Milioa, Jean Kellera, Jean Andersona and Cynthia Argania a
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; bDepartment of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
Downloaded by [New York University] at 12:45 27 May 2015
(Received 22 May 2014; accepted 10 December 2014) Women with perinatally acquired HIV (PAH) face unique psychosocial challenges due to the presence of a lifelong chronic illness and often unstable living situations. With advances in HIV treatment, an increasing number of those with PAH are reaching childbearing age and becoming pregnant. Depression may be an important and common factor that complicates both treatment and pregnancy outcomes in this group. We conducted a retrospective cohort study in pregnant patients with PAH to determine if history of depression is associated with nonadherence to antiretroviral therapy (ART). We reviewed charts of women with PAH receiving prenatal care at a single institution from March 1995 to December 2012. ART nonadherence was measured by patient self-report of any missed doses in the third trimester. Demographic, obstetric, and HIV infection characteristics of patients with a history of depression (dPAH) were compared to patients without a history of depression. Nine pregnancies among 6 dPAH women and 14 pregnancies among 12 PAH women without a history of depression were identified. None of the dPAH women reported 100% adherence to ART in the third trimester while 57% of women without a history of depression reported strict adherence (p = 0.04). The mean HIV RNA level at delivery was higher among dPAH women (17,399 vs. 2966 copies/Ml; p = 0.03) and fewer reached an undetectable HIV RNA level (80% adherence (Nachega et al., 2012). There are no data available on the effect of depression on ART adherence and virologic control in pregnant women with PAH. In this study, we examine the
*Corresponding author. Email: [email protected] Present address: Sangini S. Sheth, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA. Accepted for poster presentation at the 33rd Annual Pregnancy Meeting, Society for Maternal–Fetal Medicine, San Francisco, CA, USA, February 14–16, 2013. © 2015 Taylor & Francis
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obstetric and HIV infection characteristics of pregnant women with PAH and a history of depression (dPAH) and compare them to PAH women without a history of depression.
Wilcoxon–Mann–Whitney test using Stata 12.0 (StataCorp, College Station, TX, USA). The study received approval by the Johns Hopkins Medicine Institutional Review Board.
Materials and methods
Results
We conducted a retrospective review of all pregnant women with PAH who received care at a single urban, tertiary care academic medical center from March 1995 to October 2012. For women with multiple pregnancies during the study period, each pregnancy was analyzed separately. PAH women with pregnancy losses, terminations, or loss to follow-up were excluded. Pregnant PAH women received prenatal and HIV care from a small group of specialty obstetric providers with infectious disease specialist consultation as needed. At their initial visit patients were asked if they were ever diagnosed with depression by a medical provider. Any patient reporting a diagnosis of depression was included in the dPAH group. Self-reported adherence to ART was assessed at each prenatal visit. Clinical data were abstracted from the maternal medical record. The main outcome measure was report of 100% ART adherence in the third trimester among dPAH versus PAH women without a history of depression. Data were analyzed using Fisher’s exact test or
Twenty PAH women had 25 pregnancies; all deliveries occurred from 2005 to 2012. Two women were excluded from the study for pregnancy termination or loss to follow-up. Six women with 9 pregnancies (39%) had a history of depression and 12 women with 14 pregnancies had no history of depression. Over 50% of PAH pregnancies were reported to be unintended (Table 1). In 15 pregnancies, women were prescribed combination ART (cART) in the first trimester and continued through pregnancy. For six pregnancies, cART was started in the second trimester. One patient was started on zidovudine alone in the third trimester and another patient was started on cART in the second trimester but not continued in the third trimester due to nonadherence. dPAH women demonstrated worse immunologic and virologic parameters compared to those without a history of depression (Table 2). The mean peak HIV RNA level during pregnancy was higher among dPAH women (p = 0.003) and mean HIV RNA level at delivery was more than five times higher (p = 0.03). An undetectable HIV
Table 1. Baseline characteristics of pregnancies in women with PAH by depression history.
Age at delivery, mean (SD) Range Race, % (n) Black White Nulliparous, % (n) Unintended pregnancy, % (n) Gestational age at delivery, mean (SD) Less than 37 weeks, % (n) Single marital status, % (n) HIV status disclosed to father of baby Father of baby supportive/involved Has social support Education level, % (n) 8th grade or less 9–12th, no diploma Diploma or GED Some college Substance abuse, this pregnancy, % (n) Tobacco Alcohol Illicit drugs a
Overall (N = 23)
Depression (N = 9)
No depression (N = 14)
20 (2.6) 16–25
20 (3.3) 16–25
20 (2.2) 17–25
92 9 52 57 38 13 100 65 61 74 4 35 22 17
(21) (2) (12) (13)a (1.5) (3) (23) (15)b (14)c (17)c
78 22 44 66 38 11 100 56 44 67
(7) (2) (4) (6)a (0.9) (1) (9) (5)b (4)c (6)c
100 0 57 50 38 14 100 71 71 79
(14) (8) (7)a (1.8) (2) (14) (10) (10)c (11)c
(1) (8) (5) (4)
17 (1) 67 (4) 0 17 (1)
0 33 (4) 42 (5) 26 (3)
30 (7) 4 (1) 22 (5)
44 (4) 11 (1) 22 (2)
21 (3) 0 21 (3)
Five women with undocumented pregnancy intent, two without history of depression, and three dPAH. One dPAH woman with undocumented disclosure/involvement. c Two women with undocumented father of baby involvement or social support, one without history of depression, and one dPAH. b
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Table 2. Obstetric and HIV infection characteristics by depression history.
Downloaded by [New York University] at 12:45 27 May 2015
Depression (N = 9) CD4 count at prenatal care initiation, cells/μL Mean (range) Median (IQR) CD4 nadir during pregnancy, cells/μL Mean (range) Median (IQR)
AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV a
a
b
a
a
Sangini S. Sheth , Jenell Coleman , Tirza Cannon , Lorraine Milio , Jean Keller , Jean a
Anderson & Cynthia Argani
a
a
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA b
Click for updates
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA Published online: 23 Jan 2015.
To cite this article: Sangini S. Sheth, Jenell Coleman, Tirza Cannon, Lorraine Milio, Jean Keller, Jean Anderson & Cynthia Argani (2015) Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 27:3, 350-354, DOI: 10.1080/09540121.2014.998610 To link to this article: http://dx.doi.org/10.1080/09540121.2014.998610
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
AIDS Care, 2015 Vol. 27, No. 3, 350–354, http://dx.doi.org/10.1080/09540121.2014.998610
Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV Sangini S. Shetha*, Jenell Colemana, Tirza Cannonb, Lorraine Milioa, Jean Kellera, Jean Andersona and Cynthia Argania a
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; bDepartment of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
Downloaded by [New York University] at 12:45 27 May 2015
(Received 22 May 2014; accepted 10 December 2014) Women with perinatally acquired HIV (PAH) face unique psychosocial challenges due to the presence of a lifelong chronic illness and often unstable living situations. With advances in HIV treatment, an increasing number of those with PAH are reaching childbearing age and becoming pregnant. Depression may be an important and common factor that complicates both treatment and pregnancy outcomes in this group. We conducted a retrospective cohort study in pregnant patients with PAH to determine if history of depression is associated with nonadherence to antiretroviral therapy (ART). We reviewed charts of women with PAH receiving prenatal care at a single institution from March 1995 to December 2012. ART nonadherence was measured by patient self-report of any missed doses in the third trimester. Demographic, obstetric, and HIV infection characteristics of patients with a history of depression (dPAH) were compared to patients without a history of depression. Nine pregnancies among 6 dPAH women and 14 pregnancies among 12 PAH women without a history of depression were identified. None of the dPAH women reported 100% adherence to ART in the third trimester while 57% of women without a history of depression reported strict adherence (p = 0.04). The mean HIV RNA level at delivery was higher among dPAH women (17,399 vs. 2966 copies/Ml; p = 0.03) and fewer reached an undetectable HIV RNA level (80% adherence (Nachega et al., 2012). There are no data available on the effect of depression on ART adherence and virologic control in pregnant women with PAH. In this study, we examine the
*Corresponding author. Email: [email protected] Present address: Sangini S. Sheth, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA. Accepted for poster presentation at the 33rd Annual Pregnancy Meeting, Society for Maternal–Fetal Medicine, San Francisco, CA, USA, February 14–16, 2013. © 2015 Taylor & Francis
Downloaded by [New York University] at 12:45 27 May 2015
AIDS Care
351
obstetric and HIV infection characteristics of pregnant women with PAH and a history of depression (dPAH) and compare them to PAH women without a history of depression.
Wilcoxon–Mann–Whitney test using Stata 12.0 (StataCorp, College Station, TX, USA). The study received approval by the Johns Hopkins Medicine Institutional Review Board.
Materials and methods
Results
We conducted a retrospective review of all pregnant women with PAH who received care at a single urban, tertiary care academic medical center from March 1995 to October 2012. For women with multiple pregnancies during the study period, each pregnancy was analyzed separately. PAH women with pregnancy losses, terminations, or loss to follow-up were excluded. Pregnant PAH women received prenatal and HIV care from a small group of specialty obstetric providers with infectious disease specialist consultation as needed. At their initial visit patients were asked if they were ever diagnosed with depression by a medical provider. Any patient reporting a diagnosis of depression was included in the dPAH group. Self-reported adherence to ART was assessed at each prenatal visit. Clinical data were abstracted from the maternal medical record. The main outcome measure was report of 100% ART adherence in the third trimester among dPAH versus PAH women without a history of depression. Data were analyzed using Fisher’s exact test or
Twenty PAH women had 25 pregnancies; all deliveries occurred from 2005 to 2012. Two women were excluded from the study for pregnancy termination or loss to follow-up. Six women with 9 pregnancies (39%) had a history of depression and 12 women with 14 pregnancies had no history of depression. Over 50% of PAH pregnancies were reported to be unintended (Table 1). In 15 pregnancies, women were prescribed combination ART (cART) in the first trimester and continued through pregnancy. For six pregnancies, cART was started in the second trimester. One patient was started on zidovudine alone in the third trimester and another patient was started on cART in the second trimester but not continued in the third trimester due to nonadherence. dPAH women demonstrated worse immunologic and virologic parameters compared to those without a history of depression (Table 2). The mean peak HIV RNA level during pregnancy was higher among dPAH women (p = 0.003) and mean HIV RNA level at delivery was more than five times higher (p = 0.03). An undetectable HIV
Table 1. Baseline characteristics of pregnancies in women with PAH by depression history.
Age at delivery, mean (SD) Range Race, % (n) Black White Nulliparous, % (n) Unintended pregnancy, % (n) Gestational age at delivery, mean (SD) Less than 37 weeks, % (n) Single marital status, % (n) HIV status disclosed to father of baby Father of baby supportive/involved Has social support Education level, % (n) 8th grade or less 9–12th, no diploma Diploma or GED Some college Substance abuse, this pregnancy, % (n) Tobacco Alcohol Illicit drugs a
Overall (N = 23)
Depression (N = 9)
No depression (N = 14)
20 (2.6) 16–25
20 (3.3) 16–25
20 (2.2) 17–25
92 9 52 57 38 13 100 65 61 74 4 35 22 17
(21) (2) (12) (13)a (1.5) (3) (23) (15)b (14)c (17)c
78 22 44 66 38 11 100 56 44 67
(7) (2) (4) (6)a (0.9) (1) (9) (5)b (4)c (6)c
100 0 57 50 38 14 100 71 71 79
(14) (8) (7)a (1.8) (2) (14) (10) (10)c (11)c
(1) (8) (5) (4)
17 (1) 67 (4) 0 17 (1)
0 33 (4) 42 (5) 26 (3)
30 (7) 4 (1) 22 (5)
44 (4) 11 (1) 22 (2)
21 (3) 0 21 (3)
Five women with undocumented pregnancy intent, two without history of depression, and three dPAH. One dPAH woman with undocumented disclosure/involvement. c Two women with undocumented father of baby involvement or social support, one without history of depression, and one dPAH. b
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Table 2. Obstetric and HIV infection characteristics by depression history.
Downloaded by [New York University] at 12:45 27 May 2015
Depression (N = 9) CD4 count at prenatal care initiation, cells/μL Mean (range) Median (IQR) CD4 nadir during pregnancy, cells/μL Mean (range) Median (IQR)
