Efecto de la terapia de comportamiento cognitivo en los síntomas depresivos entre los pacientes ambulatorios infectados con VIH en Kenia

World Health Organisation estimates of 2012 indicated that about 350 million people were suffering from depression globally (WHO, 2012). The development of depression among individuals can be as result of a combination of biological, situational and psychological factors (Barlow & Durand, 2005). In HIV infection, biological factors including poor immunity, and the occurrence of multiple opportunistic infections coupled with psychological variables such as fear of death and dying from a terminal illness, stigma, as well as the distress that may be related to HIV diagnosis may play a precipitating role in the development of depression (Hand, Phillips, & Dudgeon, 2006; Lichenstein, Laska, & Clair, 2002; Simbayi, 2007). Depression among persons living with HIV (PLWH) has been associated with numerous adverse outcomes including poor immunity, higher viral loads and lower CD4 counts when compared to the non-depressed HIV positive controls (Leserman, 2008). The presence of depression in HIV positive individuals is associated with impaired innate cells, which are responsible for mediating the development of HIV to AIDS (Cruess, et alii, 2005). Depression in PLWH has also been associated with faster patient progression from HIV to AIDS and early death (Cruess et alii, 2005; Ironson et alii, 2005; Leserman, Petitto, Golden, Gaynes, & Gu, 2000). A study on HIV positive men found that those with depression progressed faster from an asymptomatic state to full blown AIDS at an average of 1.5 years quicker than the non-depressed controls (Page-Shafer, Delorenze, Satariano, & Winkelstein, 1996). Similarly, Ickovics et alii (2001) studied HIV-infected women and found that those with depression were almost 2 times more likely to die from AIDS compared to the non-depressed controls over a 7 year study period.One mechanism that may contribute to the association between depression and faster progression from HIV to AIDS is poor adherence to antiretroviral therapy (ART). A number of researchers have reported that depression is an important predictor of poor adherence to medications including antiretroviral treatment in PLWH (Ammassari et alii, 2004; Bartlett, 2002; Crespaz et alii, 2008; Gonzalez, Batchelder, Psaros, & Safren, 2011). It is important for HIV positive patients to adhere to ART, since successful viral suppression requires close to 95% adherence to ART (Chesney, 2003) and nonadherence may make patients become vulnerable to drug resistance, and perhaps spread such resistant strains to HIV negative individuals (Akena, Joska, Obuku, & Stein, 2013). Studies conducted in sub-Saharan Africa settings have demonstrated that depression is a commonly-occurring disorder among PLWH. A systematic review by NakimuliMpungu et alii (2011) put the prevalence of depressive disorders at 31% and that of major depression at 18% across HIV clinics in sub-Saharan Africa. The prevalence of depressive disorders among PLWH in Kenya has been reported to be as high as 42% (Ndetei et alii, 2009). Studies conducted in western Kenya setting have reported similar trends with results showing that as high as between 13% and 25% of PLWH in this region are presenting with major depression (Adina, 2016; Monahan et alii, 2008). The above findings highlight the fact that depression could be a burden to PLWH within the region and in the local settings. Most importantly, depression could be a burden due to its tendency to cause both cognitive and functional impairments among its victims if not intervened for in a timely fashion. The most common approaches in treating depression include the use of medication and/or psychotherapy. Psychological therapies are accredited for the benefit of helping a person to recover and also help to prevent relapse into depression (Jorm, Morgan, & Hetrick, 2008) albeit at a cheaper cost than pharmacological treatment.Among the psychological therapies commonly used for depression treatment in diverse settings is cognitive behavior therapy (CBT). …