The effect of sertraline on depression and associations with persistent depression in survivors of HIV-related cryptococcal meningitis

Background: Depression is associated with worse outcomes in persons living
with HIV/AIDS and has a prevalence more than three times as high as in the
general population. Despite this, there are few randomized studies of
antidepressants in HIV-infected Africans. Methods: We enrolled 460
HIV-infected Africans with cryptococcal meningitis into a randomized
clinical trial of adjunctive sertraline vs placebo (2015-2017). We
screened for clinical depression using the Center for Epidemiologic
Studies Depression Scale (CES-D) at one and three months after meningitis
diagnosis and initiation of treatment. We evaluated the relationship
between sertraline and depression, as well as associations with persistent
depression, at three months. Results: At one- and three-months post
meningitis diagnosis, 62% (108/174) and 44% (74/169) of all subjects had
depression (CES>15), respectively. At three months,
sertraline-treated subjects were non-significantly more likely to be
depressed than placebo-treated subjects (64% vs 37%, p=0.09) but were
significantly less likely to have severe depression (CES>26) (OR
0.335; 95%CI, 0.130-0.865). Of those with depression at one month,
sertraline-treated subjects were less likely than placebo-treated subjects
to be depressed at three months (p=0.05). Sertraline was the only factor
we found significant in predicting persistent depression at three months
among those who had depression at one month. Conclusions: Depression is
highly prevalent in HIV-infected persons who have survived cryptococcal
meningitis. We found that sertraline is associated with a modest reduction
in depression in those with depression at baseline and a significant
reduction in severe depression.