Comparative effectiveness of dual vs. single-action antidepressants on HIV clinical outcomes in HIV-infected people with depression

Jon C. Mills, Jeffrey S. Harman, Robert L. Cook, Nicole M. Marlow, Christopher A. Harle, R. Paul Duncan, Bradley N. Gaynes, Brian W. Pence

Research output: Contribution to journalArticle

9 Scopus citations


Objective: Depression is highly prevalent among people living with HIV/AIDS (PLWHA) and has deleterious effects on HIV clinical outcomes. We examined changes in depression symptoms, viral suppression, and CD4 + T cells/μl among PLWHA diagnosed with depression who initiated antidepressant treatment during routine care, and compared the effectiveness of dual-action and single-action antidepressants for improving those outcomes. Design: Comparative effectiveness study of new user dual-action or single-action antidepressant treatment episodes occurring from 2004 to 2014 obtained from the Center for AIDS Research Network of Integrated Clinical Systems. Methods: We identified new user treatment episodes with no antidepressant use in the preceding 90 days. We completed intent-to-treat and per protocol evaluations for the main analysis. Primary outcomes, were viral suppression (HIV viral load <200 copies/ml) and CD4 + T cells/μl. In a secondary analysis, we used the Patient Health Questionnaire-9 (PHQ-9) to evaluate changes in depression symptoms and remission (PHQ <5). Generalized estimating equations with inverse probability of treatment weights were fitted to estimate treatment effects. Results: In weighted intent-to-treat analyses, the probability of viral suppression increased 16% after initiating antidepressants [95% confidence interval=(1.12, 1.20)]. We observed an increase of 39 CD4 + T cells/μl after initiating antidepressants (30, 48). Both the frequency of remission from depression and PHQ-9 scores improved after antidepressant initiation. Comparative effectiveness estimates were null in all models. Conclusion: Initiating antidepressant treatment was associated with improvements in depression, viral suppression, and CD4 + T cells/μl, highlighting the health benefits of treating depression in PLWHA. Dual and single-action antidepressants had comparable effectiveness.

Original languageEnglish (US)
Pages (from-to)2515-2524
Number of pages10
Issue number18
StatePublished - Nov 28 2017



  • CD4 +
  • comparative effectiveness research
  • depression
  • second-generation antidepressive agents
  • viral load

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Mills, J. C., Harman, J. S., Cook, R. L., Marlow, N. M., Harle, C. A., Duncan, R. P., Gaynes, B. N., & Pence, B. W. (2017). Comparative effectiveness of dual vs. single-action antidepressants on HIV clinical outcomes in HIV-infected people with depression. AIDS, 31(18), 2515-2524.