Beyond total depressive symptoms: Differential associations between depressive domains, HIV status and disease...

People with HIV (PWH) are at two times greater risk for major depressive disorder (MDD) than people without HIV (PWoH), which manifests in symptoms across cognitive, somatic, affective, apathy, and anhedonia domains that may differentially impact clinical outcomes. However, few studies have examined whether HIV and its characteristics relate to depressive symptom domains.

This secondary, cross-sectional analysis included 3456 participants enrolled in studies at the UCSD HIV Neurobehavioral Research Program and CHARTER sites between 2000 and 2023 (79 % PWH, 78 % male, Age: M = 47.8). Depressive symptom domains were assessed with the Beck Depression Inventory (BDI-II). Multivariable linear regression models evaluated associations between HIV, HIV disease characteristics, and depressive symptom domains while controlling for covariates.

HIV diagnosis was significantly associated with higher severity across depressive symptom domains (affective: B = 0.51, cognitive: B = 0.44, somatic: B = 1.55, anhedonia: B = 0.52, apathy: B = 0.58, all ps < 0.05) and overall depressive symptoms (BDI-II total: B = 2.51, p < 0.01) while adjusting for covariates. Among PWH, HIV viral suppression was associated with fewer overall depressive symptoms, driven by fewer cognitive and somatic symptoms (ps < 0.01), while higher current CD4⁺ T-cell count was associated with fewer affective and apathy symptoms (ps < 0.05).

HIV diagnosis was associated with higher depressive symptoms across all domains. Current HIV disease indicators and duration of HIV disease were associated with select depressive domains to varying degrees, except for the anhedonia domain. These findings highlight the potential importance of examining individual symptom domains as they differentially associate with varying aspects of HIV disease, which may provide insight into specific treatment targets.