Catherine R Lesko1, Jonathan V Todd2, Stephen R Cole2, Andrew Edmonds2, Brian W Pence2, Jessie K Edwards2, Wendy J Mack3, Peter Bacchetti4, Anna Rubtsova5, Stephen J Gange6, Adaora A Adimora7. 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.
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.
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