Work

Depression and HIV Infection Are Associated With Higher Risks of All-Cause Mortality in US Veterans: A Cohort Study

Year: 2016

Type: article

Abstract: Background. Depression is associated with greater systemic inflammation and an increased frequency of cardiovascular events in the HIV-infected population. However, previous studies have been mixed with respect to the association between depression and mortality in HIV. We hypothesized that both depression and HIV infection would predict all-cause mortality. Methods. We tested this hypothesis both in the Veterans Aging Cohort Study (VACS) Virtual Cohort (VC), where baseline major depressive disorder (MDD) was identified by International Classification of Diseases, ninth revision codes (77,232 HIV-/MDD-; 14,606 HIV-/MDD + ; 34,150 HIV + /MDD-; 7030 HIV + /MDD+), and in the subset participating in the VACS Biomarker Cohort (BC), where baseline depression was defined as a Patient Health Questionnaire (PHQ)-9 score ≥10 (572 HIV-/PHQ-9 <10; 263 HIV-/PHQ-9 ≥10; 1175 HIV + / PHQ-9 <10; 348 HIV + / PHQ-9 ≥10). Cox proportional hazard models were constructed to examine the risk for all-cause mortality by baseline depression and HIV-infection status while controlling for demographics, body mass index, traditional cardiovascular disease risk factors, substance use, hepatitis C virus coinfection, reduced renal function, hemoglobin, and use of statin drugs. Results. Median (interquartile range [IQR]) time of follow-up in the VC was 10.0 (5.6–12.1) years and in the BC was 8.8 (8.0–9.3) years. In adjusted Cox models, the hazard ratios (95% confidence interval [CI]; P value) for mortality in the VC for the HIV-/MDD + , HIV + /MDD-, and HIV + /MDD+ groups compared with the HIV-/MDD- group were, respectively, 1.07 (1.03–1.12; P = 0.001), 1.49 (1.45–1.54; P < 0.001), and 1.57 (1.50–1.65; P < 0.001). The hazard ratios (95% CI; P value) for mortality in the BC for the HIV-/PHQ-9 ≥10, HIV + /PHQ-9 <10, and HIV + /PHQ-9 ≥10 groups compared with the HIV-/PHQ-9 <10 group were, respectively, 1.36 (0.99–1.85; P = 0.06), 1.33 (1.04–1.70; P = 0.021), and 1.51 (1.12–2.03; P = 0.007). Conclusion. In separate analyses using both diagnostic codes and a more sensitive instrument for identifying depression, we found that depression in combination with HIV infection was strongly associated with increased all-cause mortality in US Veterans. Disclosures. S. Gupta, Gilead Sciences: Grant Investigator, Investigator and Scientific Advisor, Consulting fee, Research grant, Research support and Travel support to scientific conferences; Bristol-Myers Squibb: Investigator, Research support and Travel support to scientific conferences; Janssen Therapeutics: Grant Investigator and Investigator, Research grant and Research support

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.1727

Authors: Samir Gupta, Kaku So-Armah, Jesse Stewart, Joyce Chang, Joseph L. Goulet, Matthew Freiberg