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

• Type of Material: Article
• Authors: Catherine R. Lesko, Johns Hopkins Bloomberg School of Public Health; Jonathan V. Todd, University of North Carolina; Stephen R. Cole, University of North Carolina; Andrew Edmonds, University of North Carolina; Brian W. Pence, University of North Carolina; Jessie K. Edwards, University of North Carolina; Wendy J. Mack, University of Southern California; Peter Bacchetti, University of California San Francisco; Anna Rubtsova, Emory University; Stephen J. Gange, Johns Hopkins Bloomberg School of Public Health; Adaora A. Adimora, Johns Hopkins Bloomberg School of Public Health
• Language: English
• Date: 2017-12-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.annepidem.2017.08.021
• Title of Journal or Parent Work: Annals of Epidemiology
• ISSN: 1047-2797
• Volume: 27
• Issue: 12
• Start Page: 783
• End Page: 789
• Grant/Funding Information: This analysis was supported by National Institutes of Health grants U01 AI103390, R01 AI100654 and U01 HL121812.; WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA).; The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH).; WIHS (Principal Investigators): UAB-MS WIHS (Michael Saag, Mirjam-Colette Kempf, and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos), U01-AI- 035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Mary Young and Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Joel Milam), U01-HD-032632 (WIHS I – WIHS IV).; Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health.; Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS).; The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH).
• Keywords: HIV; Public, Environmental & Occupational Health; Survival analysis; Life Sciences & Biomedicine; IMMUNODEFICIENCY-VIRUS-INFECTION; THERAPY; ADHERENCE; Science & Technology; INITIATION; OUTCOMES; Antiretroviral therapy; Mortality; CAUSAL INFERENCE; Cohort studies; Depression; EXPOSURES; SYMPTOMS; INTERAGENCY HIV; INDIVIDUALS
• Research Categories: Health Sciences, Immunology; Health Sciences, Public Health

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.