Associations Between Depressive Symptoms and Memory Functions in Persons with HIV: A Systematic Review and Meta-Analysis.

Episodic memory impairment can persist in persons with HIV (PWH) despite treatment. Depression is among the most prevalent comorbidities in HIV. Changes to brain regions involved in episodic memory like the hippocampus and the prefrontal cortex have been well documented in depression. If episodic memory changes occur in PWH, it is important to understand the potential impact of concurrent depressive symptoms (DS). Thus, our objective was to conduct a systematic review and meta-analysis on the role of DS in episodic memory in PWH. We included cross-sectional and longitudinal studies that provided episodic memory test scores and a formal assessment of DS expecting that episodic memory in PWH (A) be lower with comorbid DS; (B) negatively correlated with DS severity and incidence of clinical depression; and (C) declines over time with comorbid depression. Following PRIMSA guidelines, 3505 papers were identified, of which 44 studies were ultimately included. Meta-analysis demonstrated that immediate but not delayed recall were lower in PWH with DS than without DS, with small average effect sizes. An inverse relationship between DS severity and episodic memory performance emerged in about a quarter of the studies, with a higher likelihood in studies measuring incidence of clinically elevated DS. If observed, longitudinal memory decline was limited to moderately-severely depressed PWH. Our results suggest that prevention and treatment of clinical levels of depressive symptomatology in PWH remains a paramount target in HIV care with important implications for memory and likely other cognitive functions long-term.