Depression and Survival Among HIV-Infected Persons

To the Editor.  —We previously reported^1,2 that depression, defined by Center for Epidemiologic Studies Depression Scale (CES-D) score, is not associated with a more rapid time to acquired immunodeficiency syndrome (AIDS) or death or with a more rapid decline in CD4 cell count among human immunodeficiency virus type 1 (HIV-1)—infected AIDS-free homosexual men participating in the Multicenter AIDS Cohort Study (MACS).We are currently studying pre-AIDS depression, which consists of a dramatic increase in CES-D—based depressive symptomatology occurring 12 to 18 months before AIDS (by the 1987 Centers for Disease Control and Prevention clinical definition³). These changes in severity of depression, at a time of multiple psychological and biological stressors, raises the question as to whether depression at later stages of HIV infection is different from depression at earlier stages. It might be hypothesized that depressive symptoms at late stages of HIV infection are associated with more rapid