Depression: an individual-level early warning indicator of virologic failure in HIV patients in South Africa

 OBJECTIVE: To identify individual-level early warning  indicators of virologic failure in HIV patients receiving  antiretroviral therapy (ART) in South Africa. 

 DESIGN: A matched case–control study of individuals  with and without virologic failure (VF) (>5 months on ART  and HIV-1 plasma viral load >1,000 copies/mL) was  conducted between June 2014 and June 2018. Of the  1,000 participants enrolled in the parent cohort, 96 experienced VF, and 199 additional controls were identified  from the parent cohort and matched 1:2 (some matched  1:3) for sex, age, ART duration, and site. Participants were  interviewed while clinical, pharmacy refill, laboratory, and  objective pharmacological data were obtained. Multivariate conditional logistic regression models were constructed using model selection to identify factors  associated with VF. Significant determinants of VF were  identified using an alpha level of 0.05.  

RESULTS: In a full conditional model, higher cumulative  ART adherence, quantified using tenofovir-diphosphate  concentrations in dried blood spots (OR 0.26) and medication possession ratio (OR 0.98) were protective against  VF, whereas an increase in total depression score (OR 1.20)  was predictive of VF. 

CONCLUSION: This analysis demonstrates the importance of depression as a key individual-level early warning  indicator of VF. Efforts to address mental health concerns  among patients with people