The prevalence of mental health disorders in people with HIV and the effects on the HIV care continuum

Lang, Raynell; Hogan, Brenna; Zhu, Jiafeng; McArthur, Kristen; Lee, Jennifer; Zandi, Peter P.; Nestadt, Paul S.; Silverberg, Michael J.; Parcesepe, Angela M.; Cook, Judith Α.; Gill, M John; Grelotti, David J.; Closson, Kalysha; Lima, Viviane D.; Goulet, Joseph L.; Horberg, Michael A.; Gebo, Kelly A.; Camoens, Reena M; Rebeiro, Peter F.; Nijhawan, Ank E.; McGinnis, Kathleen A.; Eron, Joseph J.; Althoff, Keri N.

doi:10.1097/qad.0000000000003420

Cited by 20 publications

(11 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This can introduce stochasticity that leads to the wide range of outcomes reported in Table 2. Recent cohort data suggest that prevalence of depression among persons with HIV increases with time since initiation of ART [4,72]. However, other evidence suggests that depression onset may be less common among older persons and more common in the years immediately following diagnosis [73,74].…”

Section: Discussionmentioning

confidence: 99%

Closing the gaps in the continuum of depression care for persons with HIV: modeling the impact on viral suppression in the United States

Koenig

Khurana

Islam

et al. 2023

Aids

View full text Add to dashboard Cite

Objective:Depression is prevalent among persons with HIV (PWH) and is associated with poorer adherence and lack of viral load suppression (VLS). When treated for depression, PWH are more likely to stay in HIV care and adhere to medications; however, for many PWH, depression is not adequately diagnosed or treated. We adapted Progression and Transmission of HIV (PATH 3.0), a U.S. agent-based dynamic stochastic simulation model, by incorporating a continuum of depression care and estimating the impact on VLS of an enhanced depression diagnosis and care scenario (EDC).Methods:We compared EDC – whereby every PWH is assessed for depression, gets treatment if diagnosed, and of those, half achieve remission – to a status quo scenario (SQ) on VLS. Based on published findings, assumptions for SQ were: 34.7% depressed, 45% diagnosed, 55.3% treated and 33% of treated achieving remission. Compared to PWH without depression, we assumed the probability of being non-virally suppressed increased by 1.57 times for PWH with depression (PWH-D), and by 0.95 times for PWH with remitted depression.Results:There was an average increase of 14.6% (11.5–18.5) in the proportion of PWH-D who achieved VLS in EDC compared to SQ. Among all PWH, there was a 4.7% (3.4–6.0) increase in the proportion who achieved VLS in EDC compared to SQ.Conclusions:Fully diagnosing and adequately treating depression would improve health and quality of life for a substantial proportion of PWH-D and result in a nearly 5% increase in expected rates of VLS in the United States, supporting national prevention goals.

show abstract

Section: Discussionmentioning

confidence: 99%

Closing the gaps in the continuum of depression care for persons with HIV: modeling the impact on viral suppression in the United States

Koenig

Khurana

Islam

et al. 2023

Aids

View full text Add to dashboard Cite

show abstract

“…Importantly, we have also found more than twice the risk of death in index participants with moderate or severe depression. The causal pathway of this association is described by multiple studies showing the negative impact of depression at each stage of HIV treatment continuum: care engagement [ 28 ], ART initiation and adherence [ 29 – 31 ], and viral suppression [ 32 , 33 ], resulting in higher mortality [ 34 – 36 ]. However, some studies reported an independent effect of depression on mortality, controlling for the effects of adherence [ 37 , 38 ] and clinical variables [ 35 , 39 ], potentially suggesting other mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial

Dumchev

Guo

et al. 2023

BMC Infect Dis

View full text Add to dashboard Cite

Introduction The HIV Prevention Trials Network (HPTN) 074 study demonstrated a positive effect of an integrated systems navigation and psychosocial counseling intervention on HIV treatment initiation, viral suppression, medication assisted treatment (MAT) enrollment, and risk of death among people who inject drugs (PWID). In this sub-study, we analyzed the incidence, causes, and predictors of death among HIV-infected and uninfected participants. Methods The HPTN 074 randomized clinical trial was conducted in Indonesia, Ukraine, and Vietnam. HIV-infected PWID with unsuppressed viral load (indexes) were recruited together with at least one of their HIV-negative injection partners. Indexes were randomized in a 1:3 ratio to the intervention or standard of care. Results The trial enrolled 502 index and 806 partner participants. Overall, 13% (66/502) of indexes and 3% (19/806) of partners died during follow-up (crude mortality rates 10.4 [95% CI 8.1–13.3] and 2.1 [1.3–3.3], respectively). These mortality rates were for indexes nearly 30 times and for partners 6 times higher than expected in a population of the same country, age, and gender (standardized mortality ratios 30.7 [23.7–39.0] and 5.8 [3.5–9.1], respectively). HIV-related causes, including a recent CD4 < 200 cells/μL, accounted for 50% of deaths among indexes. Among partners, medical conditions were the most common cause of death (47%). In the multivariable Cox model, the mortality among indexes was associated with sex (male versus female aHR = 4.2 [1.5–17.9]), CD4 count (≥ 200 versus < 200 cells/μL aHR = 0.3 [0.2–0.5]), depression (moderate-to-severe versus no/mild aHR = 2.6 [1.2–5.0]) and study arm (intervention versus control aHR = 0.4 [0.2–0.9]). Among partners, the study arm of the index remained the only significant predictor (intervention versus control aHR = 0.2 [0.0–0.9]) while controlling for the effect of MAT (never versus ever receiving MAT aHR = 2.4 [0.9–7.4]). Conclusions The results confirm that both HIV-infected and uninfected PWID remain at a starkly elevated risk of death compared to general population. Mortality related to HIV and other causes can be significantly reduced by scaling-up ART and MAT. Access to these life-saving treatments can be effectively improved by flexible integrated interventions, such as the one developed and tested in HPTN 074.

show abstract

“…Over the same time period, the overall attendance rate of scheduled HIV primary care visits at the Owen Clinic was 88%, whereas our 12‐month rate of retention in care was 77.3%. Nearly 80% of patients in our survey had either SUD, unstable housing, or a MHD, all of which are known barriers to both engagement and retention in care [16, 17, 21]. SUD itself was highly correlated with the presence of an MHD, unstable housing, lack of HIV virological suppression, and missed discharge clinic appointments and 30‐day clinic follow‐up.…”

Section: Discussionmentioning

confidence: 99%

Effects of a hospital discharge clinic among people with HIV: Lack of early follow‐up is associated with 30‐day hospital readmission and decreased retention in care

Hill,

Thompson,

Balcombe

et al. 2023

HIV Medicine

View full text Add to dashboard Cite

BackgroundThe transition between inpatient and outpatient care for hospitalized people with HIV represents an opportunity for linkage and re‐engagement in care. We evaluated whether attendance at a post‐hospitalization visit (‘discharge clinic’) within 1–2 weeks of discharge would reduce readmissions and improve retention in care (RIC) among people with HIV in San Diego, California, USA.MethodsThis was a retrospective cohort study of people with HIV hospitalized between June 2020 and November 2021. Our primary outcome was 30‐day readmissions among people with HIV who did or did not attend a discharge clinic visit. Secondary outcomes included the effect of discharge clinic attendance on RIC, along with the impact of attendance at any HIV clinic visit within 30 days of discharge on readmissions and RIC.ResultsWe evaluated 114 people with HIV, of whom 77 (67.5%) and 90 (78.9%) attended a discharge clinic visit or any HIV clinic visit within 30 days of discharge, respectively. Active substance use disorder (SUD) was associated with failing to attend a discharge clinic visit (odds ratio 0.31; 95% confidence interval 0.13–0.77). We observed no significant differences in readmissions between people with HIV who did or did not attend a discharge clinic visit; however, the former had significantly higher 6‐month RIC (79.2% vs. 35.1%, p < 0.001). People with HIV attending any HIV clinic visit within 30 days of discharge had significantly fewer 30‐day readmissions (8.9% vs. 29.2%, p = 0.02) and better 6‐month RIC (75.6% vs. 25%, p < 0.001) than those who did not attend.ConclusionEarly hospital follow‐up care was associated with a reduction in readmissions among people with HIV. Active SUD was a significant barrier to linkage to outpatient follow‐up and RIC.

show abstract

The prevalence of mental health disorders in people with HIV and the effects on the HIV care continuum

Cited by 20 publications

References 52 publications

Closing the gaps in the continuum of depression care for persons with HIV: modeling the impact on viral suppression in the United States

Closing the gaps in the continuum of depression care for persons with HIV: modeling the impact on viral suppression in the United States

Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial

Effects of a hospital discharge clinic among people with HIV: Lack of early follow‐up is associated with 30‐day hospital readmission and decreased retention in care

Contact Info

Product

Resources

About