Achieving improvements in the depression treatment cascade will likely require attention to substance use and psychiatric comorbidities among persons living with HIV (PLWH), according to a recent study. Researchers conducted a cross-sectional analysis in a large cohort of PLWH in routine care and analyzed conditional probabilities of having an indication for depression treatment, receiving treatment, receiving indicated treatment adjustments, and achieving remission, stratified by alcohol use, illicit drug use, and panic symptoms. Overall, 34.7% of participants had an indication for depression treatment and of these, 55.3% were receiving antidepressants. Researchers found:

• Among patients receiving antidepressants, 33.0% had evidence of remitted depression. In a subsample of sites with antidepressant dosage data, only 8.8% of patients received an indicated treatment adjustment.
• Current drug users (45.8%) and patients reporting full symptoms of panic disorder (75.0%) were most likely to have an indication for antidepressant treatment, least likely to receive treatment given an indication (current drug use: 47.6%; full panic symptoms: 50.8%), or have evidence of remitted depression when treated (22.3%; and 7.3%, respectively).