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 Lesko, Peter Bacchetti, Mardge H. Cohen, Daniel J. Feaster, Stephen J Gange, Michael E. Griswold, Wendy Mack, Anna Rubtsova, Cuiwei Wang, Jeremy Weedon, Kathryn Anastos, Adaora A. Adimora

Research output: Contribution to journalArticle

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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HIV
Depression
Mortality
Confidence Intervals
Therapeutics
Structural Models
Joints

Keywords

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

ASJC Scopus subject areas

  • Epidemiology

Cite this

Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women. / Todd, Jonathan V.; Cole, Stephen R.; Pence, Brian W.; Lesko, Catherine; Bacchetti, Peter; Cohen, Mardge H.; Feaster, Daniel J.; Gange, Stephen J; Griswold, Michael E.; Mack, Wendy; Rubtsova, Anna; Wang, Cuiwei; Weedon, Jeremy; Anastos, Kathryn; Adimora, Adaora A.

In: American Journal of Epidemiology, Vol. 185, No. 10, 15.05.2017, p. 869-878.

Research output: Contribution to journalArticle

Todd, JV, Cole, SR, Pence, BW, Lesko, C, Bacchetti, P, Cohen, MH, Feaster, DJ, Gange, SJ, 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
Todd, Jonathan V. ; Cole, Stephen R. ; Pence, Brian W. ; Lesko, Catherine ; Bacchetti, Peter ; Cohen, Mardge H. ; Feaster, Daniel J. ; Gange, Stephen J ; Griswold, Michael E. ; Mack, Wendy ; Rubtsova, Anna ; Wang, Cuiwei ; Weedon, Jeremy ; Anastos, Kathryn ; Adimora, Adaora A. / Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women. In: American Journal of Epidemiology. 2017 ; Vol. 185, No. 10. pp. 869-878.
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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.",
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AU - Mack, Wendy

AU - Rubtsova, Anna

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