Reductions in HIV risk behaviors among depressed drug injectors

Am J Drug Alcohol Abuse. 2005;31(3):417-32. doi: 10.1081/ada-200056793.

Abstract

Objective: To determine if, by reducing depressive symptoms, combined psychotherapy and pharmacotherapy reduces HIV drug risk behavior compared to an assessment-only condition for active drug injectors over 9 months.

Design: Randomized controlled trial.

Setting: Outpatient academic research office.

Patients: Active injection drug users with a DSM-IV diagnosis of major depression, dysthymia, substance-induced mood disorder with depressive features persisting for at least 3 months, or major depression plus dysthymia. In addition, participants had a Hamilton Rating Scale for Depression (MHRSD) score > 13.

Intervention: Psychotherapy (8 sessions of cognitive behavioral therapy) plus antidepressant pharmacotherapy over 3 months.

Main outcome measures: HIV Risk Assessment Battery (RAB) drug scale scores measured at three, six and nine months, and depression remission (MHRSD score < or = 8).

Results: Participants (n= 109) were 64% male, 82% Caucasian, with a mean baseline MHRSD score of 20.7. Depression subtypes included major depression only (63%), substance-induced depression (17%), and double-depression (17%). Overall, study retention at nine months was 89%. Reported HIV drug risk scores decreased sharply over the first 3 months and continued to decline throughout the follow-up period. Between group differences were not significant in the intention-to-treat analysis. However, highly adherent participants had significantly lower HIV drug risk scores at 3 months (p<05), but not 6 and 9 months. Depression remission was significantly associated with lower HIV drug risk scores at follow-ups.

Conclusions: Combined psychotherapy and pharmacotherapy did not produce a significant reduction in HIV drug risk beyond that seen in an assessment-only control group. The greatest declines in HIV drug risk were found in participants with high protocol adherence and those with depression remission.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Antidepressive Agents / therapeutic use*
  • Cognitive Behavioral Therapy*
  • Combined Modality Therapy
  • Comorbidity
  • Depressive Disorder / epidemiology
  • Depressive Disorder / therapy*
  • Female
  • HIV Infections / prevention & control*
  • Humans
  • Male
  • Rhode Island / epidemiology
  • Risk Reduction Behavior*
  • Statistics, Nonparametric
  • Substance Abuse, Intravenous / epidemiology
  • Substance Abuse, Intravenous / psychology*

Substances

  • Antidepressive Agents