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Ann Epidemiol. 2017 Dec;27(12):783-789.e2. doi: 10.1016/j.annepidem.2017.08.021. Epub 2017 Sep 5.

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

Author information

1
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: clesko2@jhu.edu.
2
Department of Epidemiology, University of North Carolina, Chapel Hill.
3
Department of Preventive Medicine, University of Southern California, Los Angeles, CA.
4
Division of Biostatistics, University of California, San Francisco.
5
Department of Behavioral Sciences/Health Education, Emory University, Atlanta, GA.
6
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
7
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, University of North Carolina School of Medicine, Chapel Hill.

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.

KEYWORDS:

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

PMID:
28939001
PMCID:
PMC5714697
DOI:
10.1016/j.annepidem.2017.08.021
[Indexed for MEDLINE]
Free PMC Article

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