August 7, 2002
Lead author Dr. Amy M. Kilbourne of the Veterans Administration Pittsburgh Center for Health Equity Research and Promotion explained that physicians have long been aware that depressed patients with HIV report more symptoms than non- depressed patients with HIV. "Yet clinicians are given little guidance as to what to do in response to symptoms reported by depressed patients," she noted. "Should clinicians first treat the depression and observe whether the symptom resolves, or should they also search for the medical causes of the symptom?"
Kilbourne and colleagues used data from a large-scale study of 881 HIV patients treated at Veterans Administration Medical Centers in Cleveland, Houston and Manhattan between June 1999 and July 2000. The investigators surveyed patients' medical records to determine the severity of their illness, the nature and number of their HIV symptoms, and how bothersome those symptoms were. The researchers simultaneously assessed each participant's level of depression. The team followed the patients' medical progress during the following year.
At the one-year mark, the authors found, those patients who had begun the study with the highest number of HIV disease symptoms were more likely to be among the 53 participants who died. Because severe depression and serious symptoms often go hand in hand, many of those who died had been severely depressed when first interviewed. However, analysis revealed that the severity of a patient's symptoms -- regardless of level of depression -- was the strongest predictor of whether that person would live or die in the coming year.
Pain & Central Nervous System Week