A Comparative study of the clinical features of major depression between HIV-positive and HIV-negative patients at Butabika and Mulago hospitals.
Akena, Dickens Howard
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INTRODUCTION: HIV/AIDS is one of the greatest health crises the world faces today with sub-Saharan Africa, being the worst affected. In Uganda, a recent demographic survey found a prevalence of 7%. Patients with HIV/AIDS suffer a wide range of neuropsychiatric disorders with depression being the commonest psychiatric disorder at a prevalence of 22%-32%. There is paucity of data on mental health problems associated with HIV/AIDS. Currently no studies have been in Uganda to describe the clinical features of major depression in HIV/AIDS. OBJECTIVE: This study aimed at comparing the clinical features of major depression between HIV-Positive and HIV-negative patients with a view to recommending management strategies. METHODS: A comparative descriptive cross-sectional study was carried out on 64 HIV-Positive depressed patients and 66HIV-negative depressed patients in Butabika and Mulago hospitals. They were compared along the parameters of clinical features of depression, physical examination and laboratory parameters using the MINI, BDI, WHO staging and the socio-demographics. Pair wise comparisons were done for the two groups using means chi-squares and frequencies. Logistic regression and Multivariate analysis was done for associations. RESULTS: Compared to HIV-Negative patients, HIV,-Positive patients were more likely to be widowed (p=0.003); had later onset of depressive illness (at ≥years; p=0.003); were more likely to be older (≥ 30years, P=0.009) and less likely to have a family member with a mental illness (p=0.0032). On the MINI, compared to HIV-negative patients, HIV positive patients were more likely to have appetite changes (p=0.017) and less sleep problems (p=0.020). On the general patient characteristic, compared to HIV Negative patients, HIV positive patients were also more likely to have a medical illness and to have been taking medication before onset of depressive symptoms (p<0.001 and p=0.002) respectively. The HIV positive patients also differed on the BDI subscale scores by being less critical of themselves (p=0.014); had significantly less problems making decisions (p=0.050); had significantly less poor sleep (p=0.050) and were significantly less easily tired (p=0.005). The depression in HIV-positive patients was more common in those being in WHO stage I and II. However, compared to HIV negative patients, more HIV positive patients showed cognitive impairment on MMSE (p=0.029). Low CD4 counts were not significantly associated with their depression. CONCLUSION: These results showed that the clinical features of depression and their associations are different between HIV-positive and HIV-negative groups. Depression in HIV/AIDS seemed to occur earlier in the disease (WHO stages of I and II) and was not associated with decreasing immunity as seen by the CD4+ counts but with cognitive impairments. Depression in the HIV- positive group occurred later on in life (>30 years) and was not associated with a family history of mental illness. These results suggest that the clinical features and associations of depression were different among HIV-Positive and HIV-Negative patients. They call for routine screening for depression in HIV/AIDS, routine testing for HIV in late-onset depression as well as cognitive testing in all depressed HIV-positive patients.