Depression in Older Adults Living with HIV

• Major depression and dysthymic disorder are estimated to be higher in people living with HIV than among non-infected individuals.
• Chronic depression can inhibit immune response to certain vaccines, such herpes zoster vaccine.
• Depression may also increase in inflammatory markers, such as interleukin 6 and tumor necrosis factor further adding to disease burden. In addition, inflammation may be causal for the onset of depression; chronic inflammation may be an underlying mechanism for the associations among age, HIV, depression and multi-morbidity.
• This model below shows various interrelationships among depression and other health factors, with connections going in almost every direction. For example, depression can adversely affect adherence to ART and other treatments.
  
  
  Conceptualization of Multi-morbidity and Depression. Adapted from Havlik, R. J., Brennan, M. & and Karpiak, S. E. (2011). Comorbidities and depression in older adults with HIV. Sexual Health, 8, 551-559.
• Depression is one of the most frequently endorsed conditions in HIV-infected older adults.
• In older adults living with HIV, there is some plateauing of depressive symptoms with increasing age, but they do not achieve the lower levels seen in HIV-negative older adults in the general population.
• Suicide rates remain high in older adults living with HIV, and depression is a major issue that requires attention.
• Depression is also related to physical comorbidities, with severity of depression correlating positively with between the number of medical diseases/conditions.
• Experiencing more depressive symptoms may increase the likelihood of people living with HIV also experiencing vision and hearing loss, dermatological problems, heart and respiratory conditions, diabetes, impotence and broken bones.

Multimorbidity and depression in HIV-infected older adults - Psychology and AIDS Exchange, January 2014

Brennan, M., Karpiak, S. E., Shippy, A. R., & Cantor, M. H. (Eds., 2009). Older Adults with HIV: An in-depth examination of an emerging population. New York: Nova Science Publishers.