Association between depressive symptoms and adherence to highly active antiretroviral therapy in HIV-positive women is dependent of menopausal status: a secondary analysis from a Peruvian series

Abstract

Background: The adherence to highly active antiretroviral therapy (HAART)is key to the therapeutic success of HIV patients and associated to depressive symptoms (DS)in several studies. However, there are few publications regarding mid-aged women; a period in which the menopausal status could play an important role. Objective(s): Assess the effect of menopausal status over the association between DS and adherence to HAART in mid-aged women with HIV infection. Method(s): This was a secondary analysis of a primary survey in Lima, Peru that included 313 women (40 to 59 years). Adherence to HAART was assessed with the Spanish language version of the Assessment of Adherence to Antiretroviral Therapy Questionnaire (ATAEQ-HIV)and DS with the Patient Health Questionnaire (PHQ-9). Menopausal status was classified according to Stages of Reproductive Aging Workshop criteria (STRAW)as premenopausal, perimenopausal and postmenopausal. In addition, other socio-demographic and clinical variables were measured such as age, used HAART scheme, time of disease and comorbidities. We performed generalized linear models Poisson family with bias-corrected and accelerated non-parametric bootstrap to estimate prevalence ratios (PR)and their 95% CIs. Result(s): Mean age of studied women was 47.5 +/- 5.4 years, with 23.9% being premenopausal and 52.4% postmenopausal; 19.81% had DS and only 29.4% had adherence to HAART. We found that menopausal status had an effect modification on the association between DS and non-adherence. Therefore, we performed an analysis for each menopausal status, where being depressed was associated with non-adherence in premenopausal (PR = 1.39, 95% CI: 1.19-1.63)and postmenopausal women (PR = 1.64, 95% CI: 1.43-1.89); nevertheless, no association was observed among perimenopausal women (PR = 1.16, 95% CI:0.75-1.79). Conclusion(s): Our findings suggest that the menopausal status has an effect over the association between DS and non-adherence to HAART, in which the association was found only among pre- and postmenopausal women.Copyright © 2019