Association between depressive symptoms and neurocognitive impairment in people with well-treated HIV in Switzerland. International Journal of STD & AIDS
Santos et al. aimed to analyse the association between depressive symptoms and neurocognitive impairment (NCI) in a population of well-treated, ageing people with HIV (PWH).
PWH aged ≥45 years underwent neurocognitive assessment and grading of depressive symptoms using the Centre for Epidemiological Studies Depression Scale. Neurocognitive impairment categories were defined using Frascati criteria. Participants with NCI related to neurological or psychiatric confounders other than depression were excluded.
Excluding 79 participants with confounding factors, 902 participants were studied: 81% were men; 96% had plasma viral loads <50 copies/ml; 35% had neurocognitive impairment; 28% had Centre for Epidemiological Studies Depression scores ≥16. Higher Centre for Epidemiological Studies Depression scores were associated with female sex (p = 0.0003), non-Caucasian origin (p = 0.011) and current/past intravenous drug use (p =0.002). Whilst neurocognitive impairment was associated with higher Centre for Epidemiological Studies Depression scores, the Centre for Epidemiological Studies Depression score was a poor predictor of having neurocognitive impairment (area under the ROC curve 0.604). Applying a Centre for Epidemiological Studies Depression score threshold of 16 predicted the presence of neurocognitive impairment with a sensitivity of 38.3% (specificity 77.2%), increasing the threshold to 27 lowered sensitivity to 15.4% (specificity 93.6%).
In conclusion, this large cohort study of PWH in Switzerland sheds light on the limitations of Centre for Epidemiological Studies Depression score thresholds in the context of HIV-associated NCI. Applying conventional Centre for Epidemiological Studies Depression score thresholds to predict NCI had no benefit. As NCI was associated with higher Centre for Epidemiological Studies Depression scores; however, the study data support the screening for and treatment of depression among PWH diagnosed with NCI.