Effects of depression and anxiety on antiretroviral therapy adherence among newly diagnosed hiv-infected chinese men who have sex with men.

Abstract To explore the effect of depression and anxiety on adherence to antiretroviral therapy (ART) among men who have sex with men (MSM) with newly diagnosed HIV infections. We conducted a prospective study of Chinese MSM with newly diagnosed HIV infections. The Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety at baseline, 6 and 12 months, separately. ART adherence was self-reported once every three months ("perfect" or no missing dose in the past three months vs. "imperfect" adherence or at least one missing dose in the past three months). We utilized a priori substantial knowledge guided by causal models to identify confounding covariates, and performed mixed-effect logistic regression to assess the effects of depression and anxiety on ART adherence. We included 228 participants who initiated ART after HIV diagnosis and before the end of study. A one-unit increase in the depression and anxiety score was associated with a 16% increase (adjusted odds ratio [aOR], 1.16; 95% confidence interval [CI], 1.02-1.32) and a 17% increase (aOR, 1.17; 95% CI, 1.03-1.33) in the odds of reporting imperfect ART adherence, respectively. When depression and anxiety were categorized (normal, borderline, and likely), only likely anxiety had a significant association with ART adherence (aOR, 4.79; 95% CI, 1.12-20.50). Depression and anxiety are risk factors for imperfect ART adherence among Chinese MSM with newly diagnosed HIV infections. Intensive intervention on depression and/or anxiety beyond regular post HIV-testing counseling may increase adherence to ART, and improve HIV treatment outcomes.