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Depression and HIV infection: Risk factors for cardiovascular disease

White, Jessica R. (2015) Depression and HIV infection: Risk factors for cardiovascular disease. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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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
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
White, Jessica R.jrw99@pitt.eduJRW99
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBarinas-Mitchell, Emmabarinas@edc.pitt.eduEJB4
Committee MemberFreiberg, Matthewmatthew.s.freiberg@vanderbilt.edu
Committee MemberBromberger, Joycebrombergerjt@upmc.eduJBROM
Committee MemberChang, Chung Chouchangj@pitt.eduCHANGJ
Committee MemberSekikawa, Akiraakira@pitt.eduAKIRA
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: Graduate 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: 19 Dec 2016 14:42
URI: http://d-scholarship.pitt.edu/id/eprint/24517

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