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. 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.

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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

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