Anhédonie et dépression dans le contexte de l'infection par le VIH avec les multithérapies antirétrovirales (ANRS-EN12-VESPA)
Résumé
Introduction.—Anhedonia is defined as the loss of the capacity to feel pleasure and there is
no consensus with its relationship with depressive symptomatology. Furthermore, no study has
investigated the problematic of anhedonia in the context of HIV-infection, which concern a lot
of patients with depressive symptoms. Depressive symptomatology presents a major challenge
in the management of HIV-infection due to its central role in clinical progression.
Objective.—This study aims to disentangle relationship between determinants of anhedonia,
depression and anxiety in order to optimise mental management of HIV infection.
Method.—In 2003, a face-to-face survey (ANRS-EN12-VESPA) was conducted among patients
selected in a random stratified sample of 102 French hospital departments delivering HIV care.
Eligible respondents were HIV-infected outpatients, aged 18 or older living in France and diagnosed
for at least six months. Among solicited patients, 2932 agreed to participate (response
rate: 59%) and data about anhedonia, anxiety and depression are available for 1427 patients.
The face-to-face gathered information on sociodemographic characteristics, such as education
level, gender, partner, children, financial situation or housing and also psychosocial and sociobehavioural
characteristics, such as drug use. Self-reported side effects of treatment were also
available.
Assessment tools.—Anxiety and depression were assessed using the hospital anxiety and depression
(HAD) scale. Physical anhedonia was assessed using the French version of the Chapman
scale. Three regression models were used to identify factors associated with anhedonia, anxiety
and depression among demographic, psychosocial and clinical characteristics.
Results.—Factors independently associated with anhedonia were older age (>50), lower education
level, unemployment and men HIV contaminated by heterosexual relation or injecting
drug use. Women, with lower education level, unemployment, without steady partner, with
a detectable viral load and who reported side effect of HAART presented more frequently
anxiety. Unemployment, uncomfortable housing, no social support from friends, self-reported
side effect and lipodystophy were independently associated with depression.
Conclusion.—Our results underline the multiplicity of factors associated with mental disorders
related to depression. These results can be explained by the fact that the anxiety and anhedonia
are two cardinal symptoms of depression. Determinants of anhedonia and anxiety reported in
this study may provide the key to a more exact delineation of depressive disorders in the context
of HIV infection in order to optimize long-term psychological follow up of concerned patients.