2179. Depression and HIV Infection Are Associated with Higher Risks of All-Cause Mortality in U.S. Veterans: A Cohort Study
Session: Poster Abstract Session: HIV Psychiatry
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • 2179 IDWeek 2016 Poster HIV-Mortality VACS October 12 2016.pdf (213.6 kB)
  • 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 ICD-9 codes (77,232 HIV-/MDD-; 14,606 HIV-/MDD+; 34,150 HIV+/MDD-; 7,030 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, BMI, traditional CVD risk factors, substance use, HCV co-infection, reduced renal function, hemoglobin, and use of statin drugs.

    Results: Median (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% CI; p-value) for mortality in the VC for the HIV-/MDD+, HIV+/MDD-, and HIV+/MDD+ groups compared to 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 to 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 U.S. Veterans.

    Samir Gupta, MD, MS, Medicine/Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, Kaku So-Armah, PhD, School of Public Health, Boston University, Boston, MA, Jesse Stewart, PhD, Psychology, Indiana University-Purdue Univeristy Indianapolis (IUPUI), Indianapolis, IN, Joyce Chang, PhD, University of Pittsurgh, Pittsburgh, PA, Joseph L. Goulet, PhD, MS, Psychiatry, Yale School of Medicine/VACHS, West Haven, CT and Matthew Freiberg, MD, MSc, Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN

    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

    K. So-Armah, None

    J. Stewart, None

    J. Chang, None

    J. L. Goulet, None

    M. Freiberg, None

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