***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Major  depressive disorder in HIV-positive persons is often not diagnosed , and poorly treated . The effect of depression screening on case detection , and rates of antidepressant prescription is unknown . We assessed 368 participants for major depressive disorder , and provided clinicians with the results . Four weeks later , we abstract ed information from the charts of the depressed patients to ascertain if they received antidepressants . We also r and omly sample d the charts of 368 non-screened patients , to ascertain whether clinicians had diagnosed and prescribed antidepressant treatment . Major depressive disorder was identified in 17.9 % of the screened group , and in 2.1 % of the non-screened group [ OR = 9.65 , CI = ( 4.54–20.50 ) ] . The screened individuals were 7.8 times more likely to receive antidepressants  ( 95 % CI = 3.04–20.24 ) . Identification of major depressive disorder by clinicians in HIV setting s remains poor . However , routine screening can improve case detection rates and the proportion of patients receiving antidepressants BACKGROUND This study examined how severe stress and depressive symptoms were related to changes in immune measures during a 2-year period in a sample of gay men with human immunodeficiency virus ( HIV ) infection . These analyses follow up our initial cross-sectional observations that severe stress was correlated with lower levels of natural killer ( NK ) cells and CD8 + T lymphocytes in these men . METHODS Data were collected in North Carolina as part of an ongoing , longitudinal study , the Coping in Health and Illness Project . Sixty-six HIV-infected gay men , who were asymptomatic at baseline , were assessed systematic ally at 6-month intervals . RESULTS Severe stress and depressive symptoms were independently related to decreases on immune measures from entry to 2-year follow-up , that is , declines in CD8 + T cells and CD56 + and CD16 + NK cell subsets . Subjects most likely to have decreases on these immune measures were those who scored above the median on both stress and depressive symptoms . CONCLUSIONS Our findings are among the first prospect i ve data showing that stress and depressive symptoms , especially when they occur jointly , are associated with decreased number of NK and CD8 + T lymphocytes in HIV-infected men . Since these immune cells may play a protective role in the progression of HIV infection , our data suggest that stress and depressive symptoms may have clinical implication s for the course of this disease Objectives : To characterize the determinants of changes in adherence to antiretroviral therapy and examine whether there are persistent lower adherers . Design : A cohort study with repeated measurements . Methods : Self-reported 100 % adherence was defined as taking all doses and numbers of pills over a 4-day period as prescribed for current HIV medications . Independent predictors of changing adherence ( < 100 % to 100 % and 100 % to < 100 % ) were determined by logistic regression , correcting for correlated repeated measures for 597 HIV-positive men reporting the use of highly active antiretroviral therapy ( HAART ) between October 1998 and October 2000 . Results : Of the 942 visit-pairs with initial 100 % adherence , 106 ( 11.3 % ) reduced adherence to less than 100 % , and 836 ( 88.7 % ) remained 100 % adherent at the next 6-month visit . No recent outpatient visits , younger age , depression , less than college educated , and later in calendar time predicted decreasing adherence . Among 186 visit-pairs starting with less than 100 % adherence , 133 ( 71.5 % ) improved adherence to 100 % and 53 ( 28.5 % ) remained less than 100 % adherent at the next visit . The determinants of improving adherence included not being African-American , not using recreational drugs , and having had more than three HAART regimens . Lower adherence was not a r and om event ; it was significantly correlated across visits within the individual . Conclusion : Characteristics associated with improving and lowering adherence differed and should be considered in developing interventions to enhance adherence and optimize effective therapies OBJECTIVES The HIV/AIDS epidemic in China is growing and the main transmission mode has changed from contaminated blood products to sexual contact . The aim of this study was to evaluate the levels of anxiety ( SAS ; Zung Self-Rating Anxiety Scale ) and depression ( CES-D ; Center for Epidemiologic Studies Depression Scale ) among people living with HIV/AIDS ( PLWHA ) under the new epidemic characteristics and to examine associated factors . METHODS The sample size ( N=800 ) was calculated on the basis of the lowest prevalence of psychological disorders among PLWHA and was enlarged taking into consideration a loss of response . Participants were sample d r and omly among all PLWHA registered in Liaoning Province . Question naires pertaining to the SAS , CES-D , and related factors were distributed between December 2010 and April 2011 ; 772 effective responses were received . RESULTS The prevalence of anxiety ( SAS ≥40 ) and depression ( CES-D ≥16 ) were 49.0 % and 73.1 % , respectively . Multivariate logistic regression analysis revealed that SAS was associated with self-rated health , condom use at the last sexual contact , perceived social support , alcohol consumption , and transmission ; CES-D was associated with self-rated health , perceived social support , job , and sex . CONCLUSIONS PLWHA under the new epidemic characteristics in China suffer from serious psychological problems . To improve their psychological well-being , efforts should be focused on improving perceptions of their health condition and increasing perceived social support OBJECTIVE To report on the prevalence of psychiatric comorbidity and its association with illness severity in depressed HIV patients . METHODS As part of a multi-site r and omized controlled trial of depression treatment for HIV patients , 304 participants meeting criteria for current Major Depressive Disorder ( MDD ) were assessed for other mood , anxiety and substance use disorders with the Mini-International Neuropsychiatric Interview , a structured psychiatric diagnostic interview . We also assessed baseline adherence , risk , and health measures . RESULTS Complicated depressive illness was common . Only 18 % of participants experienced MDD with no comorbid psychiatric diagnoses ; 49 % had comorbid dysthymia , 62 % had ≥1 comorbid anxiety disorder , and 28 % had a comorbid substance use disorder . Self-reported antiretroviral adherence  did not differ by the presence of psychiatric comorbidity . However , psychiatric comorbidity was associated with worse physical health and functioning : compared to those with MDD alone , individuals with ≥1 comorbidity reported more HIV symptoms ( 5.1 vs. 4.1 , P=.01 ) , and worse mental health-related quality of life on the SF-12 ( 29 vs. 35 , P<.01 ) . CONCLUSION For HIV patients with MDD , chronic depression and psychiatric comorbidity are strikingly common , and this complexity is associated with greater HIV disease severity and worse quality of life . Appreciating this comorbidity can help clinicians better target those at risk of harder-to-treat HIV disease , and underscores the challenge of treating depression in this population & NA ; Depression and anxiety are common among persons recently diagnosed with HIV infection . We examined whether depression or anxiety was associated with delayed initiation of antiretroviral therapy ( ART ) among a prospect i ve cohort of Chinese men who have sex with men ( MSM ) who were newly diagnosed with HIV . The Hospital Anxiety and Depression Scale ( HADS ) was used for measuring depression and anxiety , with scores of 0–7 , 8–10 , and 11–21 representing normal , borderline , and likely , respectively . ART initiation information was extracted from the National ART Data base . Cox regression was performed to assess associations between HADS scores and the time to ART initiation . Of 364 eligible participants enrolling in the cohort within a median of 11 days after HIV diagnosis , 62 % initiated ART during the 12‐month follow‐up period . The baseline prevalence for likely/borderline depression was 36 % , and likely/borderline anxiety was 42 % . In adjusted analyses , compared with a depression score of 0 , the likelihood of starting ART was 1.82 [ 95 % confidence interval ( CI ) : 1.38–2.41 ] , 3.11 ( 95 % CI : 1.82–5.30 ) , and 2.53 ( 95 % CI : 1.48–4.32 ) times higher for depression scores of 3 , 9 , and 13 , respectively . A similar pattern was observed for the anxiety score . In contrast to our hypothesis , both depression and anxiety were associated with earlier ART initiation among Chinese MSM with newly diagnosed HIV . We speculate that individuals who are more concerned about their new HIV diagnosis may be more likely to seek HIV care and follow a doctor 's advice . The effects of depression or anxiety on ART initiation likely differ in varying subgroups and by symptom severity CONTEXT The impact of depression on morbidity and mortality among women with human immunodeficiency virus ( HIV ) has not been examined despite the fact that women with HIV have substantially higher rates of depression than their male counterparts . OBJECTIVE To determine the association of depressive symptoms with HIV-related mortality and decline in CD4 lymphocyte counts  among women with HIV . DESIGN The HIV Epidemiologic Research Study , a prospect i ve , longitudinal cohort study conducted from April 1993 through January 1995 , with follow-up through March 2000 . SETTING Four academic medical centers in Baltimore , Md ; Bronx , NY ; Providence , RI ; and Detroit , Mich. PARTICIPANTS A total of 765 HIV-seropositive women aged 16 to 55 years . MAIN OUTCOME MEASURES HIV-related mortality and CD4 cell count slope decline over a maximum of 7 years , compared among women with limited or no depressive symptoms , intermittent depressive symptoms , or chronic depressive symptoms , as measured using the self-report Center for Epidemiologic Studies Depression Scale . RESULTS In multivariate analyses controlling for clinical , treatment , and other factors , women with chronic depressive symptoms were 2 times more likely to die than women with limited or no depressive symptoms ( relative risk [ RR ] , 2.0 ; 95 % confidence interval [ CI ] , 1.0 - 3.8 ) . Among women with CD4 cell counts of less than 200 x 10(6)/L , HIV-related mortality rates were 54 % for those with chronic depressive symptoms ( RR , 4.3 ; 95 % CI , 1.6 - 11.6 ) and 48 % for those with intermittent depressive symptoms ( RR , 3.5 ; 95 % CI , 1.1 - 10.5 ) compared with 21 % for those with limited or no depressive symptoms . Chronic depressive symptoms were also associated with significantly greater decline in CD4 cell counts after controlling for other variables in the model , especially among women with baseline CD4 cell counts of less than 500 x 10(6)/L and baseline viral load greater than 10 000 copies/microL. CONCLUSIONS Our results indicate that depressive symptoms among women with HIV are associated with HIV disease progression , controlling for clinical , substance use , and sociodemographic characteristics . These results highlight the importance of adequate diagnosis and treatment of depression among women with HIV . Further research is needed to determine if treatment of depression can not only enhance the mental health of women with HIV but also impede disease progression and mortality The course of disease associated with infection with the human immunodeficiency virus varies widely . Some patients deteriorate rapidly , while others live for years , even after an illness that defines the acquired immunodeficiency syndrome ( AIDS ) . In this study , comorbidity , or the presence of concurrent health problems , was investigated prospect ively as a possible co-factor for different rates of decline in 395 homosexual/bisexual men in the San Francisco Men 's Health Study ( SFMHS ) who were infected with the human immunodeficiency virus ( HIV ) .  Comorbidity data obtained from baseline interviews included both chronic and infectious diseases as well as depression .  Smoking , alcohol , and drug use  were also examined . The most prevalent comorbid conditions were sexually transmitted diseases ( 90 % ) and hepatitis B infection ( 76 % ) . Most chronic and acute concurrent health conditions were not significant discrete predictors of survival to AIDS or death after controlling for immune status and markers of disease progression . Significantly , other risk factors ( e.g. , depression and smoking ) were found to be associated with more rapid progression . Men with symptoms of depression had a higher risk of progression of AIDS diagnosis ; the relative hazard ( RH ) was 1.4 ( 95 % confidence interval [ CI ] , 1.00 - 2.08 ) ; smoking was associated with higher risk of death ( RH , 1.6 ; 95 % CI , 1.20 - 2.17 ) . Older age was marginally associated with poorer survival to death . No associations were found between survival and alcohol and drug use OBJECTIVE To investigate whether high levels of depress 
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Heterogeneity in the prevalence of depression among the general population of PLHA was partially explained by the geographic location and baseline survey year .
Our findings suggest that the estimates of depression or depressive symptoms among PLHA in China are considerable , which highlights the need to integrate screening and providing treatment for mental disorders in the treatment package offered to PLHA , which would ultimately lead to better health outcomes in PLHA