Major Depressive Episodes and Psychiatric Symptoms Among HIV Controllers Compared With Antiretroviral-Treated People Living With HIV

Abstract Background Major depressive episodes are highly prevalent among people living with HIV (PWH), despite sustained virological suppression. However, psychiatric outcomes among HIV controllers (HIC), who maintain long-term spontaneous control of viral replication without antiretroviral therapy (ART), remain poorly characterized. We assessed major depressive episodes and psychiatric symptom profiles among HIC compared with ART-treated PWH and explored associated factors. Methods In this prospective observational study, HIC from the French multicenter ANRS CO21 CODEX cohort were compared with PWH receiving suppressive ART. Major depressive episodes were assessed using the Mini-International Neuropsychiatric Interview (M.I.N.I.), and psychiatric symptoms were evaluated using the Symptom Checklist-90–Revised. Between-group comparisons and univariable analyses were performed to identify factors associated with psychiatric outcomes. Results Ninety-eight participants were included (57 HIC and 41 ART-treated PWH). The prevalence of lifetime major depressive episodes was high in both groups and did not differ between HIC and ART-treated participants (35% vs 41%). Most psychiatric symptom dimensions were comparable between groups, although HIC showed higher interpersonal sensitivity and psychopathology composite scores on the SCL-90-R, reflecting higher psychological distress. In both groups, psychiatric outcomes were associated with preexisting psychiatric history, alcohol use, and sociodemographic factors, but not with immunovirological parameters. Conclusions Despite spontaneous viral control, HIC do not exhibit more favorable psychiatric outcomes than ART-treated PWH. The high prevalence of depressive disorders appears to be primarily driven by behavioral and sociodemographic factors and preexisting psychiatric conditions rather than immunovirological status, supporting routine psychiatric assessment in HIV care, including for HIC.