White, Jessica R.
(2015)
Depression and HIV infection: Risk factors for cardiovascular disease.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Depression, a common mental health disorder, is associated with higher risk of cardiovascular disease (CVD). Adults with HIV infection are often burdened with depression. Although both depression and HIV infection are risk factors for CVD, previous studies have not explored how co-occurring depression and HIV are associated with CVD outcomes or underlying physiology. The aim of this dissertation was to (i) measure the risk of incident heart failure (HF) with co-occurring major depressive disorder (MDD) and HIV infection; (ii) measure biomarkers of inflammation, coagulation, monocyte activation, and metabolism with depression and HIV infection; and (iii) provide a comprehensive biomarker profile associated with symptoms of major depression in HIV+ and HIV- participants. We analyzed data from the Veterans Aging Cohort Study (VACS), a prospective study of HIV+ and HIV- veterans matched on age, sex, race/ethnicity, and geographical region. In a sample of 81,427 participants, we found that those with co-occurring HIV infection and MDD had significantly higher risk of incident HF compared to HIV- participants without MDD, after adjusting for covariates. In a subset of 2,099 participants, we determined that depression was associated with higher concentrations of interleukin-6 and soluble CD14 (biomarkers for inflammation and monocyte activation) in HIV- participants but not HIV+ participants. HIV+ participants had higher concentrations of glucose and triglycerides and lower concentrations of high-density lipoprotein cholesterol with depression. In a smaller sample with more extensive biomarker data, we found a significant association between depression and lower concentrations of vascular endothelial growth factor in HIV+ participants. Neither biomarker study supported the hypothesis that co-occurring depressive symptoms and HIV infection would interact and produce excessively high concentrations of these biomarkers. The findings from this dissertation are significant for public health research and practice. Depression is extremely common and is a risk factor for CVD. In the future, investigators must elucidate specific mechanisms driving CVD risk with depression and identify effective therapies for preventing depression-related CVD morbidity and mortality in both HIV- and HIV+ adults. Meanwhile, clinicians must remain vigilant in identifying and managing depressive symptoms, especially among those who are at heightened risk for CVD due to HIV infection.
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Details
Item Type: |
University of Pittsburgh ETD
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Status: |
Unpublished |
Creators/Authors: |
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ETD Committee: |
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Date: |
29 June 2015 |
Date Type: |
Publication |
Defense Date: |
10 April 2015 |
Approval Date: |
29 June 2015 |
Submission Date: |
6 April 2015 |
Access Restriction: |
5 year -- Restrict access to University of Pittsburgh for a period of 5 years. |
Number of Pages: |
140 |
Institution: |
University of Pittsburgh |
Schools and Programs: |
School of Public Health > Epidemiology |
Degree: |
DrPH - Doctor of Public Health |
Thesis Type: |
Doctoral Dissertation |
Refereed: |
Yes |
Uncontrolled Keywords: |
depression; HIV; cardiovascular disease; heart failure; biomarkers |
Date Deposited: |
29 Jun 2015 16:30 |
Last Modified: |
01 May 2020 05:15 |
URI: |
http://d-scholarship.pitt.edu/id/eprint/24517 |
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