Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women

Jonathan V. Todd; Stephen R. Cole; Brian W. Pence; Catherine R. Lesko; Peter Bacchetti; Mardge H. Cohen; Daniel J. Feaster; Stephen Gange; Michael E. Griswold; Wendy Mack; Anna Rubtsova; Cuiwei Wang; Jeremy Weedon; Kathryn Anastos; Adaora A. Adimora

doi:10.1093/aje/kww192

Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women

Jonathan V. Todd, Stephen R. Cole, Brian W. Pence, Catherine R. Lesko, Peter Bacchetti, Mardge H. Cohen, Daniel J. Feaster, Stephen Gange, Michael E. Griswold, Wendy Mack, Anna Rubtsova, Cuiwei Wang, Jeremy Weedon, Kathryn Anastos, Adaora A. Adimora

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33 Scopus citations

Abstract

Depression affects up to 30% of human immunodeficiency virus (HIV)-infected individuals. We estimated joint effects of antiretroviral therapy (ART) initiation and depressive symptoms on time to death using a joint marginal structural model and data from a cohort of HIV-infected women from the Women's Interagency HIV Study (conducted in the United States) from 1998-2011. Among 848 women contributing 6,721 years of follow-up, 194 participants died during follow-up, resulting in a crude mortality rate of 2.9 per 100 women-years. Cumulative mortality curves indicated greatest mortality for women who reported depressive symptoms and had not initiated ART. The hazard ratio for depressive symptoms was 3.38 (95% confidence interval (CI): 2.15, 5.33) and for ART was 0.47 (95% CI: 0.31, 0.70). Using a reference category of women without depressive symptoms who had initiated ART, the hazard ratio for women with depressive symptoms who had initiated ART was 3.60 (95% CI: 2.02, 6.43). For women without depressive symptoms who had not started ART, the hazard ratio was 2.36 (95% CI: 1.16, 4.81). Among women reporting depressive symptoms who had not started ART, the hazard ratio was 7.47 (95% CI: 3.91, 14.3). We found a protective effect of ART initiation on mortality, as well as a harmful effect of depressive symptoms, in a cohort of HIV-infected women.

Original language	English (US)
Pages (from-to)	869-878
Number of pages	10
Journal	American Journal of Epidemiology
Volume	185
Issue number	10
DOIs	https://doi.org/10.1093/aje/kww192
State	Published - May 15 2017

Keywords

HIV
antiretroviral therapy
cohort studies
depression
marginal structural models
mortality
proportional hazards models
women

ASJC Scopus subject areas

Epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/aje/kww192

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Todd, J. V., Cole, S. R., Pence, B. W., Lesko, C. R., Bacchetti, P., Cohen, M. H., Feaster, D. J., Gange, S., Griswold, M. E., Mack, W., Rubtsova, A., Wang, C., Weedon, J., Anastos, K., & Adimora, A. A. (2017). Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women. American Journal of Epidemiology, 185(10), 869-878. https://doi.org/10.1093/aje/kww192

Todd, JV, Cole, SR, Pence, BW, Lesko, CR, Bacchetti, P, Cohen, MH, Feaster, DJ, Gange, S, Griswold, ME, Mack, W, Rubtsova, A, Wang, C, Weedon, J, Anastos, K & Adimora, AA 2017, 'Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women', American Journal of Epidemiology, vol. 185, no. 10, pp. 869-878. https://doi.org/10.1093/aje/kww192

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title = "Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women",

abstract = "Depression affects up to 30% of human immunodeficiency virus (HIV)-infected individuals. We estimated joint effects of antiretroviral therapy (ART) initiation and depressive symptoms on time to death using a joint marginal structural model and data from a cohort of HIV-infected women from the Women's Interagency HIV Study (conducted in the United States) from 1998-2011. Among 848 women contributing 6,721 years of follow-up, 194 participants died during follow-up, resulting in a crude mortality rate of 2.9 per 100 women-years. Cumulative mortality curves indicated greatest mortality for women who reported depressive symptoms and had not initiated ART. The hazard ratio for depressive symptoms was 3.38 (95% confidence interval (CI): 2.15, 5.33) and for ART was 0.47 (95% CI: 0.31, 0.70). Using a reference category of women without depressive symptoms who had initiated ART, the hazard ratio for women with depressive symptoms who had initiated ART was 3.60 (95% CI: 2.02, 6.43). For women without depressive symptoms who had not started ART, the hazard ratio was 2.36 (95% CI: 1.16, 4.81). Among women reporting depressive symptoms who had not started ART, the hazard ratio was 7.47 (95% CI: 3.91, 14.3). We found a protective effect of ART initiation on mortality, as well as a harmful effect of depressive symptoms, in a cohort of HIV-infected women.",

keywords = "HIV, antiretroviral therapy, cohort studies, depression, marginal structural models, mortality, proportional hazards models, women",

author = "Todd, {Jonathan V.} and Cole, {Stephen R.} and Pence, {Brian W.} and Lesko, {Catherine R.} and Peter Bacchetti and Cohen, {Mardge H.} and Feaster, {Daniel J.} and Stephen Gange and Griswold, {Michael E.} and Wendy Mack and Anna Rubtsova and Cuiwei Wang and Jeremy Weedon and Kathryn Anastos and Adimora, {Adaora A.}",

note = "Funding Information: This work was supported by the National Institutes of Health (grants U01AI103390 (WIHS-NC), R01AI100654, and P30AI50410 (CFAR)). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Mental Health. Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Deafness and other Communication Disorders, and the National Institutes of Health Office of Research on Women's Health. WIHS data collection is also supported by the University of California, San Francisco, CTSA (grant UL1-TR000004) and Atlanta CTSA (grant UL1- TR000454). Publisher Copyright: {\textcopyright} The Author 2017.",

year = "2017",

month = may,

day = "15",

doi = "10.1093/aje/kww192",

language = "English (US)",

volume = "185",

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T1 - Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women

AU - Todd, Jonathan V.

AU - Cole, Stephen R.

AU - Pence, Brian W.

AU - Lesko, Catherine R.

AU - Bacchetti, Peter

AU - Cohen, Mardge H.

AU - Feaster, Daniel J.

AU - Gange, Stephen

AU - Griswold, Michael E.

AU - Mack, Wendy

AU - Rubtsova, Anna

AU - Wang, Cuiwei

AU - Weedon, Jeremy

AU - Anastos, Kathryn

AU - Adimora, Adaora A.

N1 - Funding Information: This work was supported by the National Institutes of Health (grants U01AI103390 (WIHS-NC), R01AI100654, and P30AI50410 (CFAR)). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Mental Health. Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Deafness and other Communication Disorders, and the National Institutes of Health Office of Research on Women's Health. WIHS data collection is also supported by the University of California, San Francisco, CTSA (grant UL1-TR000004) and Atlanta CTSA (grant UL1- TR000454). Publisher Copyright: © The Author 2017.

PY - 2017/5/15

Y1 - 2017/5/15

N2 - Depression affects up to 30% of human immunodeficiency virus (HIV)-infected individuals. We estimated joint effects of antiretroviral therapy (ART) initiation and depressive symptoms on time to death using a joint marginal structural model and data from a cohort of HIV-infected women from the Women's Interagency HIV Study (conducted in the United States) from 1998-2011. Among 848 women contributing 6,721 years of follow-up, 194 participants died during follow-up, resulting in a crude mortality rate of 2.9 per 100 women-years. Cumulative mortality curves indicated greatest mortality for women who reported depressive symptoms and had not initiated ART. The hazard ratio for depressive symptoms was 3.38 (95% confidence interval (CI): 2.15, 5.33) and for ART was 0.47 (95% CI: 0.31, 0.70). Using a reference category of women without depressive symptoms who had initiated ART, the hazard ratio for women with depressive symptoms who had initiated ART was 3.60 (95% CI: 2.02, 6.43). For women without depressive symptoms who had not started ART, the hazard ratio was 2.36 (95% CI: 1.16, 4.81). Among women reporting depressive symptoms who had not started ART, the hazard ratio was 7.47 (95% CI: 3.91, 14.3). We found a protective effect of ART initiation on mortality, as well as a harmful effect of depressive symptoms, in a cohort of HIV-infected women.

AB - Depression affects up to 30% of human immunodeficiency virus (HIV)-infected individuals. We estimated joint effects of antiretroviral therapy (ART) initiation and depressive symptoms on time to death using a joint marginal structural model and data from a cohort of HIV-infected women from the Women's Interagency HIV Study (conducted in the United States) from 1998-2011. Among 848 women contributing 6,721 years of follow-up, 194 participants died during follow-up, resulting in a crude mortality rate of 2.9 per 100 women-years. Cumulative mortality curves indicated greatest mortality for women who reported depressive symptoms and had not initiated ART. The hazard ratio for depressive symptoms was 3.38 (95% confidence interval (CI): 2.15, 5.33) and for ART was 0.47 (95% CI: 0.31, 0.70). Using a reference category of women without depressive symptoms who had initiated ART, the hazard ratio for women with depressive symptoms who had initiated ART was 3.60 (95% CI: 2.02, 6.43). For women without depressive symptoms who had not started ART, the hazard ratio was 2.36 (95% CI: 1.16, 4.81). Among women reporting depressive symptoms who had not started ART, the hazard ratio was 7.47 (95% CI: 3.91, 14.3). We found a protective effect of ART initiation on mortality, as well as a harmful effect of depressive symptoms, in a cohort of HIV-infected women.

KW - HIV

KW - antiretroviral therapy

KW - cohort studies

KW - depression

KW - marginal structural models

KW - mortality

KW - proportional hazards models

KW - women

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Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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