Depression is associated with efavirenz-containing treatments in newly antiretroviral therapy initiated HIV patients in Ecuador.

BACKGROUND: It is well known that people living with HIV (PLWH) is in higher risk for the development of depression and it has also been suggested that the use of efavirenz into the antiretroviral regimens increases even that risk. OBJECTIVE: To evaluate the effect of efavirenz-containing antiretroviral regimens on the development of depression in newly ART initiated HIV patients in Ecuador. METHODS: In a prospective cohort study from June 2016 to May 2017, all newly HIV diagnosed patients at the HIV/AIDS Unit of the Hospital Eugenio Espejo in Quito, Ecuador were evaluated using the Hamilton Rating Scale for Depression followed by a second assessment 8-12 weeks after antiretroviral therapy containing efavirenz was initiated. RESULTS: A total of 79 patients, mainly males younger than 35 years were studied. Majority of them were on TDF/FTC/EFV. Initial score in Hamilton Rating Scale revealed that less than 30% had no depression symptoms while almost 40% had mild depression. However, in the second assessment, 22.6% of the subjects had a score in the Hamilton Rating Scale compatible with severe or very severe depression (RR 1.58, 95% CI 1.09 to 2.28; p = 0.05). CONCLUSION: In our cohort study, depression was much higher in patients on Efavirenz-containing treatments. Therefore, assessment for depression must be essential as part of follow-up in these patients.

Atypical Obstructive Pseudotumors in AIDS as the Initial Manifestation of Gastrointestinal Histoplasmosis.

Histoplasma capsulatum is a dysmorphic fungus distributed worldwide commonly associated with pulmonary histoplasmosis. We report the case of an unusual presentation of gastrointestinal histoplasmosis leading to the obstruction of the intestinal lumen in a 30-year-old female, HIV positive, admitted to the hospital due to chronic abdominal pain and constipation. An initial abdominal CT revealed a mass in the sigmoid colon. A further colonoscopy showed an infiltrating, friable mass obstructing 80% of the lumen staining positive for H. capsulatum. The unspecific nature of the patient's symptoms along with the unusual presentation of the infection raises awareness about the importance of including new pathologies to differential diagnoses when treating AIDS patients.