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Depression Risk Steers MDs From EFV, But EFV Takers Still Have Higher Depression Rate
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XIX International AIDS Conference, July 22-27, 2012, Washington, DC
Mark Mascolini
Analysis of a large 2005-2010 HIV patient dataset showed that clinicians routinely avoid prescribing efavirenz (EFV) for people with depression or at risk of depression [1]. Despite this shunning of efavirenz, people who take this nonnucleoside still run a higher depression risk.
This study involved HIV-positive and negative people in the Thompson Reuters MarketScan Commercial Claims and Encounters dataset from January 2005 through September 2010. The database included 16,188 HIV-positive adults with a depression diagnosis, 218,480 HIV-positive adults without depression, 5,195,825 adults in the general population with depression, and 125,503,784 adults in the general population without depression. No one in the general population group had an ICD-9 diagnosis of HIV infection. The researchers matched every HIV-positive person prescribed efavirenz with 5 randomly selected HIV-positive people who began other antiretrovirals in the same period.
HIV-positive adults had almost a 75% higher depression rate when compared with the general US population--6.90% versus 3.98% (HIV/general population ratio 1.74). This higher depression rate held at virtually the same level in each of the years from 2005 through 2010.
In the general population, higher proportions of women than men get diagnosed with depression. But this study found that equivalent proportions of HIV-positive men and women got diagnosed with depression in every study year:
2005: HIV+ men 6.67%, HIV+ women 6.52%, general population men 2.82%, general population women 4.77%
2006: HIV+ men 6.72%, HIV+ women 7.64%, general population men 2.99%, general population women 5.12%
2007: HIV+ men 6.91%, HIV+ women 6.55%, general population men 2.83%, general population women 4.90%
2008: HIV+ men 7.16%, HIV+ women 6.78%, general population men 2.87%, general population women 4.91%
2009: HIV+ men 7.16%, HIV+ women 6.92%, general population men 2.88%, general population women 4.93%
2010: HIV+ men 6.73%, HIV+ women 6.21%, general population men 2.83%, general population women 4.74%
Five factors that indicate depression or suggest depression risk were associated with sharply lower odds of getting an efavirenz prescription:
History of depression: Overall odds ratio [OR] 2005-2010: 0.20 (80% lower odds of getting efavirenz)
Female patients: Overall OR 2005-2010: 0.45 (55% lower odds of getting efavirenz)
Alcohol abuse history: Overall OR 2005-2010: 0.23 (77% lower odds of getting efavirenz)
History of depression-related comorbidity: Overall OR 2005-2010: 0.77 (23% lower odds of getting efavirenz)
History of pregnancy: Overall OR 2005-2010: 0.06 (94% lower odds of getting efavirenz)
Even though clinicians avoided prescribing efavirenz in these groups with a history or risk of depression, prescribing the nonnucleoside independently raised the odds of depression when efavirenz began in 2006 (OR 1.43), 2006-2007 (OR 1.30), 2006-2008 (OR 1.33), or 2006-2009 (OR 1.43).
When the researchers excluded people with a history of depression when they started efavirenz, taking the nonnucleoside still independently raised the odds of depression in every period when efavirenz therapy began:
2006: OR 1.53 (95% confidence interval [CI] 1.36 to 1.72)
2006-2007: OR 1.36 (95% CI 1.24 to 1.49)
2006-2008: OR 1.37 (95% CI 1.27 to 1.48)
2006-2009: OR 1.45 (95% CI 1.33 to 1.57)
"There appears to be significant channeling of efavirenz away from patients who have depression or risk related to depression," the researchers concluded.
"Despite the apparent channeling effects measured," they noted, "there remains a small increased risk of depression in patients treated with efavirenz compared to other antiretroviral therapies."
Reference
1. Wong B, Zachry W III, Tsai KT, Griffith J, Kirbach S, Gooch K. The effect of depression risk in HIV patients on antiretroviral therapy (ART) choice and the risk of subsequent depression diagnosis after exposure. XIX International AIDS Conference. July 22-27, 2012. Washington, DC. Abstract WEPE078.
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