Depression among Patients with HIV/AIDS: A Treatment Dilemma

Abstract

Increased longevity of HIV-infected individuals due to expanding pharmacological research allows a longer period of time for mood disorders to come to medical attention. A longer period of time exists in which the treatment of depression can make a difference in the quality of life, function, and course of HIV infection. Many HIV-related symptoms and concurrent treatment regimens can complicate the choices made regarding mood disorder treatments. Certain HIV/AIDS patients are at greater risk for developing depression, such as those with substance abuse/dependence. Differentiation between the clinical presentation of depression in the general population versus the HIV/AIDS population is important. Although differentiating between symptoms of depression, somatic complaints, and cognitive deficits may be difficult, specific symptoms in HIV-infected individuals prevail. Substantial evidence suggests that antidepressant therapy and psychotherapy are effective in most HIV-positive patients with major depression. One of the greatest difficulties in drug selection for the HIV-infected population is the avoidance of clinically significant drug-drug interactions between antidepressants and antiretrovirals. Evaluating the tolerability of antidepressant medications is also an important factor of effective treatment. This article attempts to clarify all the aforementioned issues pertaining to treatment choices in HIVinfected individuals suffering from depression.