Depression, early death noted in HIV cases.

Depressed men in the early stages of infection with the AIDS virus (HIV) suffer a more rapid physical decline than their nondepressed counterparts and die sooner, according to a report presented last week at the VIII International Conference on AIDS in Amsterdam. The six-year study indicates that HIV-infected men suffering from moderate to severe depression lose greater numbers of an important disease-fighting cell, tend to develop AIDS more quickly, and die sooner than their nondepressed counterparts.

"We don't know the causal connection [among these factors]," asserts physician Jeffrey H. Burack of San Francisco General Hospital, who directed the investigation. "But treating depression might potentially slow the progression of HIV disease."

Burack's findings challenge the conclusions of two previous studies in which depression and stress exerted no measurable effects on immune function among HIV-infected men (SN: 4/6/91, p.216).

Both prior investigations lasted for only six months, too short a period to pick up important immune and health effects of depression, Burack contends.

His group analyzed data collected between January 1985 and January 1991 from 330 gay and bisexual men taking part in a larger investigation known as the San Francisco Men's Health Study Upon entering the project, all participants tested positive for HIV, but showed no signs of AIDS.

The researchers assessed depression with a 20-item questionnaire used in many epidemiological studies of mental disorders. Although the questionnaire falls short of a clinical diagnosis, 65 men - nearly 20 percent of the sample - indicated they had symptoms associated with moderate to severe depression, Burack says.

CD4 cells - important components of the immune system often used to chart the progression of HIV infection - declined significantly more each year during the study among depressed men than among nondepressed males. The plummet from a normal CD4 count to a depleted count, at which point serious infections can occur, took an average of more than five years among nondepressed HIV-infected men, but only three years, eight months among their depressed counterparts, Burack says.

Over the course of the study, about one-third of both depressed and nondepressed participants died. But during the first three years of the project, 17 percent of the depressed men died - twice the mortality rate of the nondepressed group. The two groups also displayed comparable AIDS rates at six years. However, at three years, 22 percent of depressed volunteers had been diagnosed with AIDS, compared with 15 percent of nondepressed controls.

Depression waxes and wanes over time, which may explain the erasure of differences in death rates and AIDS diagnoses between three and six years after the study began, Burack notes. His team is now analyzing depression scores obtained from participants two, four, and six years after completing the initial questionnaire. This will provide a more sophisticated breakdown of the HIV-related health risks associated with depression, Burack contends.

In the meantime, accelerated CD4 declines and death rates in the three years following HIV infection appear linked to depression, he says. Some unknown viral process may promote both depression and immunological deterioration following HIV infection, Burack theorizes. Alternatively depression may hasten disease progression, either through direct effects on the immune system or in indirect ways. For instance, depressed men may show less willingness to seek out medical treatment and a greater tendency to engage in unhealthful behaviors.

"Treating depression can certainly improve the quality of life of men with HIV infection," Burack remarks. "Our study suggests that it may be able to prolong their lives as well."