[Question #4565] (Follow Up Dr Hook): Antidepressants and PEP

81 months ago

Good day,

Thanks for the responses in the previous question. The doctor is really one of my intellectual heros in the subject of HIV

This post is a follow up to my previous question regarding the article about antidepressants affecting hiv; link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978281/

1.You said “ [PEP] reduces the amount of virus present and providing less virus for the immune system to react to.” don’t antidepressants (according to the article) do the same--providing less virus for the immune system to react to, and therefore could potentially delay seroconversion?

2. If everything that the article presents is true, does it mean that antidepressants have any effect on antigen or antibodies production? If yes, then is it to the extent that would warrant a further test (4th generation). And if no, why, considering that antidepressants decrease hiv replication and infectivity (according to the study)?

3.How do the effects of the antidepressants exactly differ from that of the PEP (and how does the PEP work differently than the SSRIs according to the article) and if both the PEP and antidepressants decrease HIV, then how do they differ in their effects?

4.what is the reason that PEP delays seroconversion, and is this reason found in antidepressants’ effects on hiv?

5. What is the main theoretical import of the article? And does the conclusion of the article mean there will be an effect on the production of antigen or antibodies? If no, could you please tell me why?

H. Hunter Handsfield, MD

81 months ago

Welcome back, but sorry you found it necessary after the very clear, science based reassurance you had from Dr. Hook. We take questions in turn, and users to not select the moderators who respond. Our styles differ, but are knowledge levels, opinions, and advice cirtually never do.

You are very seriously overthinking this, and you are searching the literature without (it seems) the necessary training and knowledge to fully understand or put into context the things you are finding. One of the main conclusions of the original research paper you cited is that the actual effect of antidepressants in people with HIV could not be determined from their results, that further study would be needed. The fact that little if any research followed to settle that question is almost certainly an indicator that knowledgeable scientists saw it as a dead end, not important enough to pursue further. And providers caring for HIV infected persons and those at risk have extensive experience with patients on antidepressants (maybe 10-20% of HIV infected persons as a guess, i.e. millions of them). None of this extensive clinical experience suggests any important interaction between antidepressants and HIV diagnosis, testing, transmission to partners, or risk of HIV if exposed.

To your specific quesions:

1,5) No, the research does not document that antidepressants have any such effect. To the extent they might reduce viral load, it't by a trivial amount compared to anti-HIV drugs. In other words, it would seem the "theoretical import" of the article is believed by knowledgeable scientists to be inconsequential.

2)) This too is taking the results of that very preliminary research much too far. Such conclusions are not warranted.

3) I am not sufficiently knowledgeable about the detailed virology (biology, immunology, etc) of HIV to answer this. I suspect the same is true of Dr. Hook. As implied by my other comments, any such effect of antidepressants on HIV probably is trivial and unimportant.

4) It isn't known that PEP in fact delays seroconversion. PEP works so well that there are very few cases in which it fails to prevent HIV -- and to my knowledge none reported in the medical literature. But theoretically, if it didn't work but suppressed the virus to a point that the immune system was unable to react, then once PEP is stopped, the virus would start to replicate and the immune system would kick in -- but the time to detecable antibody would of course then be delayed in relation to the exposure event. Because of the uncertainty, most experts recommend delayed testing after concluding a course of PEP, just as a common sense precaution. But it may not be necessary.

If you have had a high risk event for HIV exposure, and are taking an antidepressant, you can be tested and rely on the results on the normal schedule. In other words, an AgAb (duo, 4th generation) blood test will be conclusive at 6 weeks. There are NO medications of any kind known to have any effect on that timing, and certainly antidepressants do not do it. Do your best to let this go and move on with your life!

HHH, MD

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81 months ago

Thanks for the response sir! Let me tell you that I have also been following your work since you started working with Medhelp. You bring relief to so many people and that's honorable sir.

my main questions are these:

1.could you please tell me how the PEP and the antidepressants exactly differ in terms of their effect on HIV?

2. If every thing presented in the article is true, does it mean there will be effect on the antigen production (I know you answered this question before)? So if no, then why, considering that antidepressants decreases HIV

3. according to the article, how did the antidepressants exactly decrease HIV. and If it decreases HIV does it mean that it has an effect on Antigen production?

4.I took the fourth generation test after 8 weeks of exposure (unprotected sex). If every single thing in the article is true (most of which I don't understand) will there be any effect on the fourth generation test? If no, why, considering it decreases HIV.

H. Hunter Handsfield, MD

81 months ago

Thanks for the comments and for the evident respect you display toward both me and Dr. Hook. Now please honor that respect by actually reading our replies. These questions have all been answered!

1) Trivial effect versus strong effect. As I said, I don't know the biological effects (especially of antidepressnts) to answer in more detail.

2) No, it doesn't necessarily mean that. Read Dr. Hook's and my previous replies.

3) Same answer.

4) Your negative 4th gen test proves you did not catch HIV. Nothing in the article you cite changes that.

Please do not ask anything else that has already been answered to the best of our abilities. Thanks.

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81 months ago

Last question: I just want to know why does (presumably) the PEP delay seroconversion and the antidepressants (according to the article) don’t?

Meaning, what does the PEP do that antidepressants don’t in terms of affecting the test results?

Many thanks doctor!!

81 months ago

And does the antidepressant affect hiv viral load?

81 months ago

Last question (and most important one.

The article mentions, “The SSRI significantly downregulated the RT response in both the acute and chronic infection models. Specifically, citalopram significantly decreased the acute HIV infectivity of macrophages. Citalopram also significantly decreased HIV viral replication in the latently infected T-cell line and in the latently infected macrophage cell line. ”

Does that mean there is a significant effect on hiv and therefore there would be delayed seroconversion. Meaning, why did they say significant, and you say it is not significant effect. I will highly appreciate the clarification sir

H. Hunter Handsfield, MD

81 months ago

"why does (presumably) the PEP delay seroconversion and the antidepressants (according to the article) don’t?" and "what does the PEP do that antidepressants don’t in terms of affecting the test results?" Explained above. Re-read my previous replies. (Antidepressants probably have no effect, in people, in suppressing HIV. PEP drugs do.)

"Last question....": The research cited is a lab study, not done in living humans. As previously discussed, that research probably is meaningless for humans with HIV.

Really, mellow out and move on. I have to note that your questions all reflect deep anxieties and unresolved emotional concerns or conflicts. You should conisder professional counseling, probably starting with the doctor who prescribed your antidepressant therapy. I suggest it from compassion, not criticism.

That concludes the two follow-ups and replies included with each question and so ends this thread. Please note the forum does not permit repeated questions on the same topic or exposure. This being your second, it will have to be your last; future new questions on this topic may receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding.

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