Duration of Cocaine Use Is Associated with a Small Increase in the Odds of Depression Among African Americans with HIV

Both depression and cocaine use are common in individuals with HIV, and are associated with worse HIV outcomes. This study investigated the relationship between cocaine use and depression among 447 African Americans with HIV receiving antiretroviral therapy (ART). This was a sub-study of a larger prospective cohort study on subclinical atherosclerotic disease in African Americans with HIV (2003–2012) that excluded individuals with known atherosclerosis or renal impairment.

• The prevalence of depression was 41% and prevalence of chronic cocaine use* was 74%.
• Cross-sectional analyses revealed that duration of cocaine use was associated with a small increase in the odds of depression—compared with no cocaine use—when adjusted for sex, years of HIV infection, and receipt of protease inhibitor (adjusted odds ratio [aOR], 1.02).
• In univariate analyses, there was no association found between other substance use (alcohol, tobacco, or other substances) and depression.

Comments:

This study raises important questions about the relationship between the duration of cocaine use and depression, and suggested a small association between the two about which clinicians caring for HIV-infected patients should be aware. Major depression was identified on chart review of psychiatrist notes rather than patient self-report of symptoms, so it is unclear whether patients being treated for (perhaps less severe) depression by their primary care providers would have been included. Cross-sectional studies cannot determine which condition came first or account for variations in the two conditions over time. Finally, the authors did not report on the adjusted odds of the association between chronic cocaine use and depression, but rather the adjusted odds of the association between the duration of cocaine use and depression, which may not be clinically significant.

Jessica S. Merlin, MD, MBA

Reference:

Hammond ER, Lai S, Wright CM, Treisman GJ. Cocaine use may be associated with increased depression in persons with HIV. AIDS Behav. 2015 [Epub ahead of print]. PMID: 26370100.