Human Immunodeficiency Virus (HIV) Treatment With Antiretroviral Therapy Mitigates the High Risk of Mental Health Disorders Associated With HIV Infection in the US Population

Djibril M Ba; Kathryn A Risher; Paddy Ssentongo; Yue Zhang; Qi Dai; Guodong Liu; Mamoudou Maiga; Xuehong Zhang; Brehima Diakite; Souleymane Dit Papa Coulibaly; Lifang Hou; Douglas L Leslie; Vernon M Chinchilli

doi:10.1093/ofid/ofad555

Human Immunodeficiency Virus (HIV) Treatment With Antiretroviral Therapy Mitigates the High Risk of Mental Health Disorders Associated With HIV Infection in the US Population

Open Forum Infect Dis. 2023 Nov 7;10(11):ofad555. doi: 10.1093/ofid/ofad555. eCollection 2023 Nov.

Authors

Affiliations

¹ Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA.
² Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
³ Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
⁴ Preventive Medicine Department, Northwestern University, Chicago, Illinois, USA.
⁵ Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
⁶ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Faculty of Medicine and Odontostomatology, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali.

Abstract

Background: Whether treatment of human immunodeficiency virus (HIV) with antiretroviral therapy (ART) is associated with lower risk of mental health disorders (MHDs) among people with HIV (PWH) remains unknown. We aim to determine the association between HIV and MHDs and whether ART alters the risk of MHDs among PWH in the US adult population.

Methods: We conducted a real-world study using the Merative MarketScan claims database (2016-2020), identifying individuals with HIV (diagnosed using International Classification of Diseases, Tenth Revision, Clinical Modification codes) and those without HIV. A multivariable stratified Cox proportional hazard regression model was conducted to examine the association of HIV treatment status with MHDs, adjusting for potential confounders. Additionally, we sought to determine the effect modification of ART on the relationship between living with HIV and MHDs.

Results: A total of 313 539 individuals, with a mean age of 44.2 (standard deviation, 11.4) years, predominantly males (81.2%), residing in the South region of the US (50.9%) were included in the present analysis. During 671 880 person-years of follow-up, 46 235 incident MHD cases occurred. In the multivariable Cox proportional hazard model, living with HIV was associated with higher risk of incident MHDs. Relative to those without HIV, the adjusted hazard ratio was 1.85 (95% confidence interval [CI], 1.79-1.92; P < .001) for those with HIV on treatment, and 2.70 (95% CI, 2.59-2.82; P < .001) for those with HIV without any treatment. Stronger associations between HIV and MHDs were observed in men relative to women, among those aged 18-34 years relative to those aged 55-63 years, and among those with no overweight/obesity relative to obese individuals (P_interaction < .001 for all).

Conclusions: HIV was associated with an increased risk of developing MHDs. However, HIV treatment mitigated the risk.

Keywords: ART; HIV; US; mental health; real-world data.