POTENTIAL NEED FOR ANTIRETROVIRAL THERAPY IN PEOPLE WITH HIV WITH DEPRESSION AND ANXIETY SYMPTOMS: A MULTICENTER CROSS- SECTIONAL STUDY IN JAPAN
Authors: Tsukiji *Mariko , Hikasa Shinichi , Ishihara Masashi , Kunimoto Yusuke , Nobori Kazuko , Kimura Takeshi , Onishi Kenta , Yamamoto Yuuki , Haruta Kyohei , Kasiwabara Yohei , Fujii Kenji , Yamazaki Shingo , Niitsu Tomihisa , Igari Hidetoshi , Ishii Itsuko 
Published: February 2025

Abstract

Background
In addition to high virological suppression, recent antiretroviral therapy (ART) has seen an increasing emphasis that improve quality of life by maintaining long-term medication adherence, taking patient convenience and preferences into consideration. There are few reports on the relationship between treatment satisfaction and medication adherence and depression and anxiety among Japanese people with HIV (PWH).

Aims
The aim of this study was to examine the relationship between treatment satisfaction and medication adherence and depression and anxiety among Japanese PWH.

Methods
A questionnaire survey and a retrospective medical record survey were administered to PWH at 11 facilities in Japan from April to December 2021. The survey items included patient background, viral road, CD4, Human Immunodeficiency Virus Treatment Satisfaction Questionnaire (HIVTSQ), Patient Health Questionnaire (PHQ-9, &gt;10 points for depression), Generalized Anxiety Disorder (GAD-7, &gt;10 points for anxiety), satisfaction with current medications, medication adherence (number of missed ART doses in the past month), and desired formulation in future, etc. Logistic regression analysis was performed. Research ethics committee of the graduate school of medicine, Chiba university (No. 4232) and the Ethics Review Board of each institution approval was obtained.

Results
679 PWH answered the questionary, 16.1% (n=109) had depression and 8.4% (n=57) had anxiety symptoms. HIVTSQ scores were significantly lower with depression and anxiety. After adjustment for confounders such as age and gender, factors commonly associated with depression and anxiety symptoms were desire for orally disintegrating tablets (OR=2.35, OR=3.85), number of psychotropic medications (OR=1.93, OR=1.64), and dissatisfaction with daily medications (OR=0.80, OR=0.77). Additionally, the factors associated with depression was dissatisfaction with side effects (OR=0.65). Factors associated with anxiety symptoms were missing a dose (OR=2.40), number of ART tablets taken (OR=1.54), younger age and copayment. Predictors for nonadherence were anxiety symptoms (OR=3.06), female (OR=2.66), age (OR=0.97), and number of concomitant medications (OR=0.89).

Conclusions
In PWH, depression and anxiety symptoms were associated with dissatisfaction with the number of psychotropic medications, taking medication daily and need for orally disintegrating tablet. Furthermore, depression was associated with dissatisfaction with side effects, and anxiety symptoms were associated with particularly forgetting to take medications, number of ART tablets, and medical costs. This study suggests that anxiety symptoms, female, younger age, and fewer number of concomitant medications were associated with nonadherence to ART, and therefore these factors should be noted in the planning of ART therapy.