Choosing Antidepressants for HIV and AIDS Patients: Insights on Safety and Side Effects

Human immunodeficiency virus (HIV) has a high comorbidity with major depression. Symptoms of depression may be attributed to ongoing HIV infection, thereby reducing the likelihood of timely treatment with antidepressants. This may contribute to the morbidity of both illnesses. This review focuses on an evidence-based approach to selecting antidepressants for first-line treatment of major depressive disorder in patients with HIV and acquired immune deficiency syndrome (AIDS). Some antidepressant medications have side effect profiles that may exacerbate the symptoms commonly seen in patients with HIV and AIDS. Others have side effects that, while normally problematic in the general population, may be helpful in counteracting the difficulties seen in HIV and AIDS patients. Other challenges in treatment include an array of possible drug-drug interactions between antidepressants and HIV medications. Clinicians should focus more on capitalizing on the side effects of psychotropic medications in this patient population than on trying to avoid drug-drug interactions.