LATEBREAKER
HIV / STI
Depression and external-cause mortality among people engaged in HIV care in an urban clinic Tiffany Hsieh* Han-Chih (Tiffany) Hsieh Richard D. Moore Anthony T. Fojo Jeanne C. Keruly LaQuita N. Snow Catherine R. Lesko
Background: Depression is a major risk factor for poor HIV (human immunodeficiency virus) clinical outcomes and death among people with HIV (PWH). Although the effect of depression on the risk of external-cause mortality in the general population has been documented, the degree to which depression impacts external- versus natural-causes of death among PWH remains unclear.
Methods: We examined the association between recent (past 12-months) depression as measured by either self-reported depressive symptoms (PHQ-810) or clinical diagnoses of depression and the risk of mortality due to external and natural causes among PWH engaged in care in a single urban HIV clinic. We followed 3,724 adults with HIV who were engaged in HIV care in the Johns Hopkins HIV Clinical Cohort (JHHCC) from 2010 to 2019 until death, loss to follow-up, or administrative censoring. We compared the cumulative incidence functions, subdistribution hazards, and cause-specific hazards of deaths due to external and due to natural causes among PWH with versus without recent depression.
Results: The 3,724 patients in our analysis contributed 241,785 person-months (20,149 person-years) of follow-up. The majority of the study participants were male (65%), Black (76%), and non-Hispanic (98%). The crude subdistribution hazard ratio (sdHR) for external-cause mortality associated with depression was 2.31 (95% confidence interval (CI): 1.21, 4.42). After adjustment for age, sex, Black race, self-reported HIV acquisition risk factors, calendar time, and insurance status, the sdHR was 2.25 (95% CI: 1.16, 4.39). Depression was associated with over twice the hazard of death due to external causes among PWH.
Conclusion: Our results showed that depression was associated with increased risks of external death among PWH in a large urban cohort. This study motivates further analyses to understand the mechanisms that could describe the interplay between depression and other modifiable factors leading to mortality for HIV- infected population.