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Depression is known to be frequent in adults with HIV and to complicate management. However, what is not so clear is how the length of depression status over time can affect outcomes. In a study of almost 6000 patients, median age 44, with 2 or more depression assessments in the period 2005 to 2015, it was possible to address this question. Using an indicator of depression chronicity (percentage of days with depression), and a determination of outcomes during follow-up, the more frequent the days with depression the more likely for the individual to miss an appointment, have increased viral loads, and be at increased risk for death. This relationship was particularly evident in those patients with the entire follow-up period with depression with a 37% increased risk of missing appointments, 23% increased viral load and a doubled mortality rate. Greater efforts to control and maintain time free of depression in adults with HIV are strongly supported.