Mortality under plausible interventions on antiretroviral treatment and depression in HIV-infected women: an application of the parametric g-formula

WIHS Investigators

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose Among HIV-infected persons, antiretroviral therapy (ART) and depression are strongly associated with mortality. We estimated reductions in 5-year mortality in Women's Interagency HIV Study participants under plausible hypothetical increases in ART initiation and reductions in depression (CES-D score≥16). Methods We followed 885 ART-naïve Women's Interagency HIV Study participants for 5 years from their first study visit after April 1998 to death or censoring. We used the parametric extended g-formula to estimate cumulative mortality under the natural course (NC) and alternative exposure distributions. Results Baseline prevalence of depression was 52% and 62% initiated ART by 5 years. Compared with mortality under NC (13.2%), immediate ART and elimination of 36% or 67% of depressive episodes were associated with risk differences (RDs) of −5.2% (95% CI: −7.7%, −2.6%) and −5.7 (95% CI: −8.7, −2.7). Compared with immediate ART and NC for depression, additionally eliminating 67% of the depressive episodes was associated with RD = −1.6 (95% CI: −3.9, 0.8). Compared with 5-year mortality under NC for ART and elimination of 67% of depression, also initiating ART immediately was associated with RD = -2.6 (95% CI: -5.0, -0.3). Conclusions Increasing ART initiation and reducing depression were associated with moderate reductions in 5-year mortality among HIV-infected women.

Original languageEnglish (US)
Pages (from-to)783-789.e2
JournalAnnals of Epidemiology
Volume27
Issue number12
DOIs
StatePublished - Dec 1 2017

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HIV
Mortality
Therapeutics

Keywords

  • Antiretroviral therapy
  • Cohort studies
  • Depression
  • HIV
  • Mortality
  • Survival analysis

ASJC Scopus subject areas

  • Epidemiology

Cite this

Mortality under plausible interventions on antiretroviral treatment and depression in HIV-infected women : an application of the parametric g-formula. / WIHS Investigators.

In: Annals of Epidemiology, Vol. 27, No. 12, 01.12.2017, p. 783-789.e2.

Research output: Contribution to journalArticle

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title = "Mortality under plausible interventions on antiretroviral treatment and depression in HIV-infected women: an application of the parametric g-formula",
abstract = "Purpose Among HIV-infected persons, antiretroviral therapy (ART) and depression are strongly associated with mortality. We estimated reductions in 5-year mortality in Women's Interagency HIV Study participants under plausible hypothetical increases in ART initiation and reductions in depression (CES-D score≥16). Methods We followed 885 ART-na{\"i}ve Women's Interagency HIV Study participants for 5 years from their first study visit after April 1998 to death or censoring. We used the parametric extended g-formula to estimate cumulative mortality under the natural course (NC) and alternative exposure distributions. Results Baseline prevalence of depression was 52{\%} and 62{\%} initiated ART by 5 years. Compared with mortality under NC (13.2{\%}), immediate ART and elimination of 36{\%} or 67{\%} of depressive episodes were associated with risk differences (RDs) of −5.2{\%} (95{\%} CI: −7.7{\%}, −2.6{\%}) and −5.7 (95{\%} CI: −8.7, −2.7). Compared with immediate ART and NC for depression, additionally eliminating 67{\%} of the depressive episodes was associated with RD = −1.6 (95{\%} CI: −3.9, 0.8). Compared with 5-year mortality under NC for ART and elimination of 67{\%} of depression, also initiating ART immediately was associated with RD = -2.6 (95{\%} CI: -5.0, -0.3). Conclusions Increasing ART initiation and reducing depression were associated with moderate reductions in 5-year mortality among HIV-infected women.",
keywords = "Antiretroviral therapy, Cohort studies, Depression, HIV, Mortality, Survival analysis",
author = "{WIHS Investigators} and Lesko, {Catherine R.} and Todd, {Jonathan V.} and Cole, {Stephen R.} and Andrew Edmonds and Pence, {Brian W.} and Edwards, {Jessie K.} and Mack, {Wendy J.} and Peter Bacchetti and Anna Rubtsova and Gange, {Stephen J.} and Adimora, {Adaora A.} and Michael Saag and Kempf, {Mirjam Colette} and Deborah Konkle-Parker and Ighovwerha Ofotokun and Gina Wingood and Kathryn Anastos and Howard Minkoff and Deborah Gustafson and Mardge Cohen and Audrey French and Mary Young and Seble Kassaye and Fischl, {Margaret A} and Lisa Metsch and Adaora Adimora and Ruth Greenblatt and Bradley Aouizerat and Phyllis Tien and Stephen Gange and Elizabeth Golub and Joel Milam",
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TY - JOUR

T1 - Mortality under plausible interventions on antiretroviral treatment and depression in HIV-infected women

T2 - an application of the parametric g-formula

AU - WIHS Investigators

AU - Lesko, Catherine R.

AU - Todd, Jonathan V.

AU - Cole, Stephen R.

AU - Edmonds, Andrew

AU - Pence, Brian W.

AU - Edwards, Jessie K.

AU - Mack, Wendy J.

AU - Bacchetti, Peter

AU - Rubtsova, Anna

AU - Gange, Stephen J.

AU - Adimora, Adaora A.

AU - Saag, Michael

AU - Kempf, Mirjam Colette

AU - Konkle-Parker, Deborah

AU - Ofotokun, Ighovwerha

AU - Wingood, Gina

AU - Anastos, Kathryn

AU - Minkoff, Howard

AU - Gustafson, Deborah

AU - Cohen, Mardge

AU - French, Audrey

AU - Young, Mary

AU - Kassaye, Seble

AU - Fischl, Margaret A

AU - Metsch, Lisa

AU - Adimora, Adaora

AU - Greenblatt, Ruth

AU - Aouizerat, Bradley

AU - Tien, Phyllis

AU - Gange, Stephen

AU - Golub, Elizabeth

AU - Milam, Joel

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Purpose Among HIV-infected persons, antiretroviral therapy (ART) and depression are strongly associated with mortality. We estimated reductions in 5-year mortality in Women's Interagency HIV Study participants under plausible hypothetical increases in ART initiation and reductions in depression (CES-D score≥16). Methods We followed 885 ART-naïve Women's Interagency HIV Study participants for 5 years from their first study visit after April 1998 to death or censoring. We used the parametric extended g-formula to estimate cumulative mortality under the natural course (NC) and alternative exposure distributions. Results Baseline prevalence of depression was 52% and 62% initiated ART by 5 years. Compared with mortality under NC (13.2%), immediate ART and elimination of 36% or 67% of depressive episodes were associated with risk differences (RDs) of −5.2% (95% CI: −7.7%, −2.6%) and −5.7 (95% CI: −8.7, −2.7). Compared with immediate ART and NC for depression, additionally eliminating 67% of the depressive episodes was associated with RD = −1.6 (95% CI: −3.9, 0.8). Compared with 5-year mortality under NC for ART and elimination of 67% of depression, also initiating ART immediately was associated with RD = -2.6 (95% CI: -5.0, -0.3). Conclusions Increasing ART initiation and reducing depression were associated with moderate reductions in 5-year mortality among HIV-infected women.

AB - Purpose Among HIV-infected persons, antiretroviral therapy (ART) and depression are strongly associated with mortality. We estimated reductions in 5-year mortality in Women's Interagency HIV Study participants under plausible hypothetical increases in ART initiation and reductions in depression (CES-D score≥16). Methods We followed 885 ART-naïve Women's Interagency HIV Study participants for 5 years from their first study visit after April 1998 to death or censoring. We used the parametric extended g-formula to estimate cumulative mortality under the natural course (NC) and alternative exposure distributions. Results Baseline prevalence of depression was 52% and 62% initiated ART by 5 years. Compared with mortality under NC (13.2%), immediate ART and elimination of 36% or 67% of depressive episodes were associated with risk differences (RDs) of −5.2% (95% CI: −7.7%, −2.6%) and −5.7 (95% CI: −8.7, −2.7). Compared with immediate ART and NC for depression, additionally eliminating 67% of the depressive episodes was associated with RD = −1.6 (95% CI: −3.9, 0.8). Compared with 5-year mortality under NC for ART and elimination of 67% of depression, also initiating ART immediately was associated with RD = -2.6 (95% CI: -5.0, -0.3). Conclusions Increasing ART initiation and reducing depression were associated with moderate reductions in 5-year mortality among HIV-infected women.

KW - Antiretroviral therapy

KW - Cohort studies

KW - Depression

KW - HIV

KW - Mortality

KW - Survival analysis

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JO - Annals of Epidemiology

JF - Annals of Epidemiology

SN - 1047-2797

IS - 12

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