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From the Department of Psychiatry (J.G.R., S.J.F., M.S., M.M.), Weill College of Medicine, Cornell University, Ithaca; and New York State Psychiatric Institute (J.G.R., S.-H.L.), New York, NY.
Address reprint requests to: Judith G. Rabkin, PhD, New York State Psychiatric Institute, Unit 51, 1051 Riverside Dr., New York, NY 10032. Email: jgr1{at}Columbia.edu
OBJECTIVE: The objectives of this study were to evaluate the psychological consequences of combination antiretroviral treatment in terms of mood, hope, and life satisfaction in men with symptomatic human immunodeficiency virus (HIV) infection or acquired immune deficiency syndrome and to compare those whose health improved with those whose health did not improve.
METHODS: One hundred seventy-three HIV+ gay or bisexual men with symptomatic HIV illness (40% nonwhite) were evaluated semiannually in a university-affiliated research program between July 1995 and December 1997. The primary outcome measures were the Structured Clinical Interview for DSM-IV, Beck Depression Inventory, Endicott Quality of Life Enjoyment and Satisfaction Questionnaire, and Beck Hopelessness Scale.
RESULTS: Psychological distress in this sample was mild to moderate at baseline. During the first 2 years that highly active antiretroviral therapy became widely available, we observed a statistically significant but clinically modest reduction in distress in the sample as a whole, with significant covariates of CD4 cell count, HIV symptoms, and social support in a mixed-effects model. Rates of clinical depression declined. However, this generalized mental health improvement was not related to individual medical improvement of markers of HIV illness progression; those classified as improved were no more likely than those who remained unimproved to report greater declines in measures of distress and hopelessness. Number of self-reported physical symptoms were directly related to distress levels.
CONCLUSIONS: A cohort effect was observed, with overall psychological improvement. Physical symptoms were more strongly related to psychological distress than were laboratory markers. Consequently, those whose CD4 cell count and HIV RNA viral load reflected successful treatment were no more likely than others to be relieved of the psychological burdens of illness.
Key Words: psychiatry • psychosocial • highly active antiretroviral therapy • naturalhistory • quality of life
Abbreviations: AIDS = acquired immune deficiency syndrome; BDI = BeckDepression Inventory; BHS = Beck Hopelessness Scale; CD4 =subset of lymphocytes used as a marker of immunosuppression in HIVdisease; DSM-IV = Diagnostic and Statistical Manual ofMental Disorders, fourth edition; HAART = highly activeantiretroviral therapy; HAM-D = Hamilton Rating Scale forDepression; HIV = human immunodeficiency virus; HIV RNA = HIVribonucleic acid; the assay measures number of copies of virus per unitof blood (plasma); QOL = Endicott Quality of Life Enjoyment andSatisfaction Questionnaire; SCID = Structured Clinical Interviewfor DSM-IV.
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