Background Although antiretroviral therapy (ART) has significantly slowed disease progression and increased longevity among people living with HIV/AIDS (PLWHA), the potential impact on psychological variables is yet poorly understood. Profound changes in the lived experience and perception of illness resulting from ART introduction could potentially influence development of depression, an especially common (25–40%) and consequential condition in PLWHA. Left untreated, depression contributes to treatment non-adherence and poorer clinical outcomes. This study thus sought to measure the association of ART with depressive symptoms among PLWHA in the Kathmandu Valley, Nepal.

Methods In this cross-sectional study, we surveyed a community-based sample of 321 PLWHA residing in the Kathmandu Valley, Nepal, using a structured, pre-tested Nepali language questionnaire with face-to-face interviews. The 21-item Beck Depression Inventory (BDI), Nepali version, was used to assess depression in participants. Data were analysed using multiple logistic regression models to examine factors associated with depression, suicidal ideation, and history of suicide attempts, adjusting for potential confounders.

Results Overall, 26% of participants had depressive symptoms, 14% reported suicidal thoughts or wishes, and 17% had ever attempted suicide. Among the 234 respondents on ART, median treatment duration was 24 (IQR: 9–39) months. Individuals being treated with ART for 2 years or less were more likely than those not using ART both to register depression on the BDI (AOR = 2.57, 95% CI: 1.08–6.11) and to report suicidal ideation (AOR = 4.08, 95% CI: 1.29–12.85). A history of attempting suicide was correlated with being on ART for more than 2 years (AOR = 3.98, 95% CI: 1.38–11.48).

Conclusion Our study shows that PLWHA treated with ART are more likely to experience depressive symptoms, particularly in the earlier treatment stages. This suggests a critical need for psychological support alongside initiation of treatment. Further work to identify specific patterns and causes of these symptoms and effective ways of managing them is recommended.