Association between depression and adherence to highly active antiretroviral therapy among adult HIV infected patients in Thailand

Background: Highly active antiretroviral therapy (HAART) reduces the morbidity and mortality in HIV-infected patients by enhancing the immunologic response and viral load suppression. Non-adherence to HAART leads to development of resistance mutation resulting in treatment failure. Depression is a common psychological problem among HIV-infected patients. However, the association between depression and adherence to HAART has not been studied in Thailand.Objectives: To estimate the prevalence of non-adherence to HAART and to determine the association of depression and related factors with adherence to HAART in Thai adult HIV-infected patients.Material and method: A cross-sectional study was conducted at King Chulalongkorn Memorial Hospital, Thailand between October 2007 and January 2008. Three hundred seventy nine participants were recruited from the immunology and sexual transmitted disease clinics. Participants completed seven questionnaires regarding socio-demographic characteristics and medication information, adherence to HAART, depression, cognitive function, alcohol use, HIV social support, and physical symptoms.Results: The prevalence of non-adherence to HAART was 34.6% and the prevalence of depression among adult HIV-infected patients was 32.2%. The statistically significant risk-factors associated with non-adherence were depression (adjusted OR=4.68; 95%CI=2.77-7.88), no past history of opportunistic infection (OR=2.13; 95%CI=1.26-3.63), using herbal medications (OR=2.44; 95%CI=1.07-5.55), and never getting a reminder of adherence to HAART (OR=2.78; 95%CI=1.29-5.98).Conclusion: Depression was a strong predictor for non-adherence to HAART among Thai HIV-infected patients. Health care providers should screen for depression among HIV-infected patients before starting HAART and motivate those with depression on adherence to HAART.