HIV in South Africa - depression and CD4 count

Abstract

Objective. Published studies on the prevalence of depressive symptoms using rating scales and the relationship between depression and immune status offer inconsistent results. Depressive symptoms are common and impact on functioning, quality of life, and health status, highlighting the importance of diagnosis and treatment of patients with HIV infection. The aim of the study was to determine the occurrence of depression among HIV-positive patients using the Beck's Depression Inventory (BDI) and to determine a relationship, if any, between depressive symptoms and CD4 count.

Method. Forty-one patients aged 18 years or more were recruited from the HIV outpatient clinic. All the subjects completed the 21-item BDI and their CD4 counts were determined. Patients who had a score of 10 or more on the BDI were considered positive for a depressive disorder.

Results. More than half (56%) of the study sample had a BDI of ≥ 10 indicating significant symptoms of depression. There was no significant difference in the CD4 counts between the depressed and non-depressed groups (p > 0.05), and no correlation between CD4 counts and BDI scores in the total study sample (r = 0.27, p > 0.05). The affective components of the BDI contributed significantly to the overall BDI score compared with the somatic component (p < 0.05).

Conclusion. The evidence from the study supports the BDI as a suitable measure for identifying those patients who meet the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for minor or major depression. The HIV epidemic is the most serious health challenge in South Africa and it is imperative that HIV-infected patients who complain of fatigue or insomnia be screened routinely for major depression, followed by a structured interview to confirm the diagnosis.