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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16 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 languageEnglish (US)
Pages (from-to)869-878
Number of pages10
JournalAmerican Journal of Epidemiology
Volume185
Issue number10
DOIs
StatePublished - May 15 2017

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Keywords

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

ASJC Scopus subject areas

  • Epidemiology

Cite this

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