Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec;27(12):783-789.e2.
doi: 10.1016/j.annepidem.2017.08.021. Epub 2017 Sep 5.

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

Catherine R Lesko  1 , Jonathan V Todd  2 , Stephen R Cole  2 , Andrew Edmonds  2 , Brian W Pence  2 , Jessie K Edwards  2 , Wendy J Mack  3 , Peter Bacchetti  4 , Anna Rubtsova  5 , Stephen J Gange  6 , Adaora A Adimora  7 ; WIHS Investigators
Collaborators, Affiliations

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

Catherine R Lesko et al. Ann Epidemiol. 2017 Dec.

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.

Keywords: Antiretroviral therapy; Cohort studies; Depression; HIV; Mortality; Survival analysis.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST: None declared.

Figures

Figure 1
Figure 1
Natural history (observed) and natural course (modeled/predicted) for (A) ART initiation and (B) prevalence of depression
Figure 2
Figure 2
Cumulative mortality curves from (A) the parametric g-formula and (B) inverse probability weighted marginal structural model under intervention regimens: 1) immediately initiate ART and never be depressed; 2) immediately initiate ART and always be depressed; 3) never initiate ART and never be depressed; and 4) always initiate ART and always be depressed
FIGURE 3
FIGURE 3
Prevalence of depressive symptoms (CES-D score ≥16) under the natural course and various interventions to reduce the probability of depressive symptoms at the next visit given depressive symptoms at a given visit. Shaded areas indicate pointwise 95% confidence intervals.
Figure 4
Figure 4
Cumulative mortality curves from the parametric g-formula for the natural course (no intervention) and interventions that would treat everyone with ART immediately and treat depressive symptoms with success rates of 34%, 67%, and 100%
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. HIV-CAUSAL Collaboration. Ray M, Logan R, Sterne JA, Hernández-Díaz S, Robins JM, et al. The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS. 2010;24(1):123–37. - PMC - PubMed
    1. Hammer SM, Squires KE, Hughes MD, Grimes JM, Demeter LM, Currier JS, et al. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical Trials Group 320 Study Team. N Engl J Med. 1997;337(11):725–33. - PubMed
    1. Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L. Depression in HIV infected patients: a review. Curr Psychiatry Rep. 2015;17(1):530. - PubMed
    1. Tegger MK, Crane HM, Tapia KA, Uldall KK, Holte SE, Kitahata MM. The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals. AIDS Patient Care STDS. 2008;22(3):233–43. - PubMed
    1. Horberg MA, Silverberg MJ, Hurley LB, Towner WJ, Klein DB, Bersoff-Matcha S, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr. 2008;47(3):384–90. - PubMed

Publication types

Substances