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

Research output: Contribution to journalArticle

15 Citations (Scopus)

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

Fingerprint

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

Todd, J. V., Cole, S. R., Pence, B. W., Lesko, C. R., Bacchetti, P., Cohen, M. H., ... Adimora, A. A. (2017). Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women. American Journal of Epidemiology, 185(10), 869-878. https://doi.org/10.1093/aje/kww192

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 R.; Bacchetti, Peter; Cohen, Mardge H.; Feaster, Daniel J.; Gange, Stephen; 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, CR, Bacchetti, P, Cohen, MH, Feaster, DJ, Gange, S, 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 R. ; Bacchetti, Peter ; Cohen, Mardge H. ; Feaster, Daniel J. ; Gange, Stephen ; 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.
@article{2251b1706c584231ba63310bf7158793,
title = "Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women",
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.",
keywords = "antiretroviral therapy, cohort studies, depression, HIV, marginal structural models, mortality, proportional hazards models, women",
author = "Todd, {Jonathan V.} and Cole, {Stephen R.} and Pence, {Brian W.} and Lesko, {Catherine R.} and Peter Bacchetti and Cohen, {Mardge H.} and Feaster, {Daniel J.} and Stephen Gange and Griswold, {Michael E.} and Wendy Mack and Anna Rubtsova and Cuiwei Wang and Jeremy Weedon and Kathryn Anastos and Adimora, {Adaora A.}",
year = "2017",
month = "5",
day = "15",
doi = "10.1093/aje/kww192",
language = "English (US)",
volume = "185",
pages = "869--878",
journal = "American Journal of Epidemiology",
issn = "0002-9262",
publisher = "Oxford University Press",
number = "10",

}

TY - JOUR

T1 - Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality among HIV-Infected Women

AU - Todd, Jonathan V.

AU - Cole, Stephen R.

AU - Pence, Brian W.

AU - Lesko, Catherine R.

AU - Bacchetti, Peter

AU - Cohen, Mardge H.

AU - Feaster, Daniel J.

AU - Gange, Stephen

AU - Griswold, Michael E.

AU - Mack, Wendy

AU - Rubtsova, Anna

AU - Wang, Cuiwei

AU - Weedon, Jeremy

AU - Anastos, Kathryn

AU - Adimora, Adaora A.

PY - 2017/5/15

Y1 - 2017/5/15

N2 - 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.

AB - 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.

KW - antiretroviral therapy

KW - cohort studies

KW - depression

KW - HIV

KW - marginal structural models

KW - mortality

KW - proportional hazards models

KW - women

UR - http://www.scopus.com/inward/record.url?scp=85020475972&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020475972&partnerID=8YFLogxK

U2 - 10.1093/aje/kww192

DO - 10.1093/aje/kww192

M3 - Article

C2 - 28430844

AN - SCOPUS:85020475972

VL - 185

SP - 869

EP - 878

JO - American Journal of Epidemiology

JF - American Journal of Epidemiology

SN - 0002-9262

IS - 10

ER -