Association between Depression and HIV Treatment Outcomes in a US Military Population with HIV Infection

Abstract Background: Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and subsequent inability to attain viral load (VL) suppression. We evaluated longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with depression. Methods: Male NHS participants with available ICD-9 data for mental health diagnoses, Center for Epidemiological Studies Depression (CES-D) measures, and self-reported adherence (SRA) were included. ART use was defined as ART initiation between 2006-2010, with follow-up through 2015. SRA was defined as taking ³95% of ART doses and continuous ART was defined as longitudinal ART use with gaps <30 days. Continuous VL suppression was defined as maintaining VLs <200 c/mL on ART. To analyze the association between depression and HIV treatment outcomes, latent class analysis was used to create classes of depression trajectories: low depression (LD), recent onset depression (ROD) and high Depression (HD). Results: Participants had a mean age of 32 (±8.3) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). Overall, older participants at HIV diagnosis had greater odds of having 95% SRA (OR 1.06, 95% CI 1.02-1.12), and African Americans had lower odds (OR 0.41, 95% CI 0.22-0.76) compared to Caucasians (OR 1.49, 95% CI 0.52-4.28). However, there was no difference in SRA by depression trajectory. Participants with HD had a trend towards taking ART continuously (OR 1.75, 95% CI 0.99-3.09), and those with ROD had significantly higher odds of virologic failure (OR 0.58, 95% CI 0.38-0.91). Conclusions: Although there was no observed association between depression and SRA, participants with ROD had lower odds of attaining the HIV treatment goal of VL suppression. Continued efforts to identify and aggressively manage mental health disorders is important to success along the HIV care continuum.

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Association between depression and HIV treatment outcomes in a US military population with HIV infection

AIDS Research and Therapy ◽

10.1186/s12981-021-00350-2 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Brandon Carney ◽

Colton Daniels ◽

Xiaohe Xu ◽

Thankam Sunil ◽

Anuradha Ganesan ◽

...

Keyword(s):

Mental Health ◽

Treatment Outcomes ◽

Latent Class ◽

Virologic Failure ◽

Hiv Treatment ◽

Hiv Care ◽

Hiv Diagnosis ◽

Lower Odds ◽

Us Military ◽

Hiv Treatment Outcomes

Abstract Background Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and subsequent inability to attain viral load (VL) suppression. We evaluated associations between depression, self-reported adherence, and longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with and without depression. Methods Male NHS participants with available ICD-9 data for mental health diagnoses, Center for Epidemiological Studies Depression (CES-D) measures, and self-reported adherence (SRA) were included. ART use was defined as ART initiation between 2006 and 2010, with follow-up through 2015. SRA was defined as taking 95% of ART doses and continuous ART was defined as longitudinal ART use with gaps < 30 days. Continuous VL suppression was defined as maintaining VLs < 200 c/mL on ART. To analyse the association between depression and HIV treatment outcomes, latent class analysis was used to create classes of depression trajectories: low depression (LD), recent onset depression (ROD) and high Depression (HD). Results Participants had a mean age of 32 (± 8.3) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). Overall, older participants at HIV diagnosis had greater odds of having 95% self-reported adherence (OR 1.06, 95% CI 1.02–1.12), and African Americans had lower odds (OR 0.41, 95% CI 0.22–0.76) compared to Caucasians (OR 1.49, 95% CI 0.52–4.28). However, there was no difference in SRA by depression trajectory. Participants with HD had an increased odds of taking ART continuously (OR 1.75, 95% CI 0.99–3.09), and those with ROD had significantly higher odds of virologic failure (OR 0.58, 95% CI 0.38–0.91). Conclusions Although there was no observed association between depression and SRA, participants with ROD had lower odds of attaining the HIV treatment goal of VL suppression. Continued efforts to identify and aggressively manage mental health disorders is important to success along the HIV care continuum.

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369. Association Between Depression and HIV Treatment Outcomes in a US Military Population with HIV Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.442 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S193-S194

Author(s):

Brandon Carney ◽

Colton Daniels ◽

Xiaohe Xu ◽

Thankam Sunil ◽

Anuradha Ganesan ◽

...

Keyword(s):

Mental Health ◽

Treatment Outcomes ◽

Hiv Treatment ◽

Hiv Care ◽

Hiv Diagnosis ◽

Art Initiation ◽

Us Military ◽

History Of ◽

Hiv Treatment Outcomes ◽

History Of Depression

Abstract Background Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and reduced rates of viral load (VL) suppression. We evaluated longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with or without a diagnosis depression. Methods Male NHS participants with available ICD-9 data for mental health diagnoses and self-reported adherence (SRA) were included (n = 549). Groups were defined as having a history of depression (n = 188, 34.2%), classified as major depressive disorder and/or anxiety disorder, or no history of depression (n = 361, 65.8%). Delay in ART initiation was defined as the time from HIV diagnosis to ART start greater than the group mean (4.91 ± 4.69 years). SRA was defined as taking ≥95% of ART doses and continuous ART was defined as longitudinal ART use with gaps < 30 days. Continuous VL suppression was defined as maintaining VLs < 200 c/mL on ART. Logistic regression analysis was performed comparing variables for those with and without a coded diagnosis of depression. Results Participants had a mean age of 33 (±8.36) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). At ART initiation, the mean CD4 count was 370 (±154 cells/μL) and 362 (±163 cells/μL) for those with and without a history of depression, respectively. Overall, older participants at HIV diagnosis had greater odds of having high SRA (OR 1.07, 95% CI 1.03–1.11), and compared with Caucasians, African Americans had lower odds of having high SRA (OR 0.43, 95% CI 0.25–0.75; table). Participants with a history of depression had greater odds of experiencing delayed ART initiation (OR 2.12, 95% CI 1.11–4.05). However, they also had greater odds of remaining on continuous ART (OR 1.38, 95% CI 0.95–2.02) during follow-up compared with those without a history of depression. Conclusion Although HIV-infected individuals with depression were more likely to experience delays in ART initiation, there were no observed differences in SRA or VL suppression. Continued efforts to identify and aggressively manage mental health disorders are important to success along the HIV care continuum. Disclosures All authors: No reported disclosures.

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Adoption of evidence-informed guidelines in prescribing protease inhibitors for HIV-Tuberculosis co-infected patients on rifampicin and effects on HIV treatment outcomes in Uganda

BMC Infectious Diseases ◽

10.1186/s12879-021-06533-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Frank Mulindwa ◽

Barbara Castelnuovo ◽

Bruce Kirenga ◽

Dennis Kalibbala ◽

Priscilla Haguma ◽

...

Keyword(s):

Treatment Outcomes ◽

Protease Inhibitors ◽

Virologic Failure ◽

Standard Dose ◽

Hiv Treatment ◽

Hiv Patients ◽

Tb Treatment ◽

One Year ◽

Hiv Treatment Outcomes ◽

Clinical Records

Abstract Background We aimed to determine how emerging evidence over the past decade informed how Ugandan HIV clinicians prescribed protease inhibitors (PIs) in HIV patients on rifampicin-based tuberculosis (TB) treatment and how this affected HIV treatment outcomes. Methods We reviewed clinical records of HIV patients aged 13 years and above, treated with rifampicin-based TB treatment while on PIs between1st—January -2013 and 30th—September—2018 from twelve public HIV clinics in Uganda. Appropriate PI prescription during rifampicin-based TB treatment was defined as; prescribing doubled dose lopinavir/ritonavir- (LPV/r 800/200 mg twice daily) and inappropriate PI prescription as prescribing standard dose LPV/r or atazanavir/ritonavir (ATV/r). Results Of the 602 patients who were on both PIs and rifampicin, 103 patients (17.1% (95% CI: 14.3–20.34)) received an appropriate PI prescription. There were no significant differences in the two-year mortality (4.8 vs. 5.7%, P = 0.318), loss to follow up (23.8 vs. 18.9%, P = 0.318) and one-year post TB treatment virologic failure rates (31.6 vs. 30.7%, P = 0.471) between patients that had an appropriate PI prescription and those that did not. However, more patients on double dose LPV/r had missed anti-retroviral therapy (ART) days (35.9 vs 21%, P = 0.001). Conclusion We conclude that despite availability of clinical evidence, double dosing LPV/r in patients receiving rifampicin-based TB treatment is low in Uganda’s public HIV clinics but this does not seem to affect patient survival and viral suppression.

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HIV treatment outcomes among newcomers living with HIV in Manitoba, Canada

Official Journal of the Association of Medical Microbiology and Infectious Disease Canada ◽

10.3138/jammi-2020-0042 ◽

2021 ◽

pp. e20200042

Author(s):

Charity Maritim ◽

Leigh McClarty ◽

Stella Leung ◽

Sharon Bruce ◽

Gayle Restall ◽

...

Keyword(s):

Treatment Outcomes ◽

Clinical Characteristics ◽

Cohort Analysis ◽

Hiv Treatment ◽

Hiv Care ◽

Similar Proportion ◽

People Living With Hiv ◽

Persons Living With Hiv ◽

Hiv Treatment Outcomes ◽

Living With Hiv

Background: Despite the overrepresentation of immigrants and refugees (newcomers) in the HIV epidemic in Canada, research on their HIV treatment outcomes is limited. This study addressed this knowledge gap by describing treatment outcomes of newcomers in comparison with Canadian-born persons living with HIV in Manitoba. Methods: Clinical data from 1986 to 2017 were obtained from a cohort of people living with HIV and receiving care from the Manitoba HIV Program. Retrospective cohort analysis of secondary data was completed using univariate and multivariate statistics to compare differences in socio-demographic and clinical characteristics and treatment outcomes among newcomers, Canadian-born Indigenous persons, and Canadian-born non-Indigenous persons on entry into HIV care. Results: By end of 2017, 86 newcomers, 259 Canadian-born Indigenous persons, and 356 Canadian-born non-Indigenous persons were enrolled in the cohort. Newcomers were more likely than Canadian-born Indigenous and non-Indigenous cohort participants to be younger and female and have self-reported HIV risk exposure as heterosexual contact. Average CD4 counts at entry into care did not differ significantly between groups. A higher proportion of newcomers was also diagnosed with tuberculosis within 6 months of entry into care (21%), compared with 6% and 0.6% of Canadian-born Indigenous non-Indigenous persons, respectively. Newcomers and Canadian-born non-Indigenous persons had achieved viral load suppression (< 200 copies/mL) at a similar proportion (93%), compared with 82% of Canadian-born Indigenous participants ( p < 0.05). Conclusions: The distinct demographic and clinical characteristics of newcomers living with HIV requires a focused approach to facilitate earlier diagnosis, engagement, and support in care.

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The Influence of Neighborhood Characteristics on HIV Treatment Outcomes Among Adults: A Scoping Review Protocol

10.21203/rs.3.rs-789609/v1 ◽

2021 ◽

Author(s):

Linda Jepkoech Kimaru ◽

Magdiel Habila ◽

Namoonga Mantina ◽

Purnima Madhivanan ◽

Elizabeth Connick ◽

...

Keyword(s):

Treatment Outcomes ◽

Scoping Review ◽

Hiv Treatment ◽

Community Level ◽

Hiv Care ◽

Neighborhood Characteristics ◽

Hiv Interventions ◽

Individual Behaviors ◽

Hiv Treatment Outcomes ◽

Living With Hiv

Abstract BackgroundThe HIV pandemic has caused enormous suffering and loss of life in the last forty years. Currently more than 34 million people have died as a result of HIV infection and over 37 million people are currently living with HIV. There have been tremendous global efforts to address the HIV pandemic and although significant progress has been made in treatment and prevention of HIV, many people living with HIV still do not have appropriate access to treatment and care. Current HIV interventions have focused more on individual factors than on community level factors. Community level factors influence individual behavior by enhancing or limiting access to- and utilization of HIV care. The objective of this scoping review is to assess and critically examine the association between neighborhood characteristics and outcomes of HIV treatment.Methods The following databases will be searched for studies published on and prior to May 31, 2021: PubMed, PsycINFO, CINAHL, and EMBASE. We will include published full text studies with both experimental and observational study designs that discussed neighborhood characteristics and HIV treatment outcomes. We will exclude abstracts only publications and studies reporting opinion. Data generated from the search will be managed using Mendeley 1.19.8. The review will be conducted using Arskey and Levac’s methodological framework for scoping reviews. A narrative synthesis will be conducted on the included studies. Discussion Sustainability of HIV interventions that focus on individual behaviors rely on the community level factors that influence those individual behaviors. This review will enhance the understanding of the impact of neighborhood characteristics on HIV treatment outcomes among adults, and possibly shed a light on potential points of intervention that will aid in improving ART initiation, ART adherence, and HIV viral load suppression.Scoping Review Registration: OSF 10.17605/OSF.IO/MD89T

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Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes

BioMed Research International ◽

10.1155/2016/2648923 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Shu Su ◽

Shifu Li ◽

Shunxiang Li ◽

Liangmin Gao ◽

Ying Cai ◽

...

Keyword(s):

Treatment Adherence ◽

Waiting Time ◽

Cox Regression ◽

Treatment Guidelines ◽

Current Treatment ◽

Hiv Treatment ◽

Hiv Care ◽

Hiv Diagnosis ◽

Treatment Data ◽

Poor Treatment

Background.Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment.Methods.A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015.Results.Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm3) contributed slowly in CD4 recovery after treatment initiation (8% less,P<0.01) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08–1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07–1.29) and mortality rate by 11% (ARR = 1.11, 1.06–1.21), based on multivariable Cox regression.Conclusion.Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly.

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Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda

AIDS ◽

10.1097/01.aids.0000433238.93986.35 ◽

2014 ◽

Vol 28 (1) ◽

pp. 115-120 ◽

Cited By ~ 84

Author(s):

Sheri D. Weiser ◽

Kartika Palar ◽

Edward A. Frongillo ◽

Alexander C. Tsai ◽

Elias Kumbakumba ◽

...

Keyword(s):

Food Insecurity ◽

Treatment Outcomes ◽

Hiv Treatment ◽

Longitudinal Assessment ◽

Antiretroviral Adherence ◽

Hiv Treatment Outcomes

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The impact of an integrated depression and HIV treatment program on mental health and HIV care outcomes among people newly initiating antiretroviral therapy in Malawi

PLoS ONE ◽

10.1371/journal.pone.0231872 ◽

2020 ◽

Vol 15 (5) ◽

pp. e0231872 ◽

Cited By ~ 3

Author(s):

Melissa A. Stockton ◽

Michael Udedi ◽

Kazione Kulisewa ◽

Mina C. Hosseinipour ◽

Bradley N. Gaynes ◽

...

Keyword(s):

Mental Health ◽

Antiretroviral Therapy ◽

Treatment Program ◽

Hiv Treatment ◽

Hiv Care ◽

Care Outcomes ◽

The Impact

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“Our Tradition Our Enemy”: A Qualitative Study of Barriers to Women’s HIV Care in Jimma, Southwest Ethiopia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17030833 ◽

2020 ◽

Vol 17 (3) ◽

pp. 833

Author(s):

Hailay Gesesew ◽

Pamela Lyon ◽

Paul Ward ◽

Kifle Woldemichael ◽

Lillian Mwanri

Keyword(s):

Treatment Outcomes ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Health Workers ◽

Hiv Treatment ◽

Hiv Care ◽

Negative Consequences ◽

Framework Analysis ◽

Southwest Ethiopia

Evidence exists that suggests that women are vulnerable to negative HIV treatment outcomes worldwide. This study explored barriers to treatment outcomes of women in Jimma, Southwest Ethiopia. We interviewed 11 HIV patients, 9 health workers, 10 community advocates and 5 HIV program managers from 10 institutions using an in-depth interview guide designed to probe barriers to HIV care at individual, community, healthcare provider, and government policy levels. To systematically analyze the data, we applied a thematic framework analysis using NVivo. In total, 35 participants were involved in the study and provided the following interrelated barriers: (i) Availability— most women living in rural areas who accessed HIV cared less often than men; (ii) free antiretroviral therapy (ART) is expensive—most women who have low income and who live in urban areas sold ART drugs illegally to cover ART associated costs; (iii) fear of being seen by others—negative consequences of HIV related stigma was higher in women than men; (iv) the role of tradition—the dominance of patriarchy was found to be the primary barrier to women’s HIV care and treatment outcomes. In conclusion, barriers related to culture or tradition constrain women’s access to HIV care. Therefore, policies and strategies should focus on these contextual constrains.

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