Institutional members access full text with Ovid®

HIV patients with psychiatric disorders are less likely to discontinue HAART

Himelhoch, Setha; Brown, Clayton Hb; Walkup, Jamesc; Chander, Geetanjalid; Korthius, P Todde; Afful, Josepha; Gebo, Kelly Ac

doi: 10.1097/QAD.0b013e32832b428f
Epidemiology and social

Objective: We examined whether having a psychiatric disorder among HIV-infected individuals is associated with differential rates of discontinuation of HAART and whether the number of mental health visits impact these rates.

Design: This longitudinal study (fiscal year: 2000–2005) used discrete time survival analysis to evaluate time to discontinuation of HAART. The predictor variable was presence of a psychiatric diagnosis (serious mental illness versus depressive disorders versus none).

Setting: Five United States outpatient HIV sites affiliated with the HIV Research Network.

Patients: The sample consisted of 4989 patients. The majority was nonwhite (74.0%) and men (71.3%); 24.8% were diagnosed with a depressive disorder, and 9% were diagnosed with serious mental illness.

Main outcome measures: Time to discontinuation of HAART adjusting for demographic factors, injection drug use history, and nadir CD4 cell count.

Results: Relative to those with no psychiatric disorders, the hazard probability for discontinuation of HAART was significantly lower in the first and second years among those with SMI [adjusted odds ratio: first year, 0.57 (0.47–0.69); second year, 0.68 (0.52–0.89)] and in the first year among those with depressive disorders [adjusted odds ratio: first year, 0.61 (0.54–0.69)]. The hazard probabilities did not significantly differ among diagnostic groups in subsequent years. Among those with psychiatric diagnoses, those with six or more mental health visits in a year were significantly less likely to discontinue HAART compared with patients with no mental health visits.

Conclusion: Individuals with psychiatric disorders were significantly less likely to discontinue HAART in the first and second years of treatment. Mental health visits are associated with decreased risk of discontinuing HAART.

aDepartment of Psychiatry, USA

bDepartment of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA

cRutgers University, Piscataway, New Jersey, USA

dDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

eDepartment of Medicine, University of Oregon Health and Science University, Portland, Oregon, USA.

Received 4 December, 2008

Revised 9 January, 2009

Accepted 16 January, 2009

Correspondence to Dr Seth Himelhoch, Department of Psychiatry, University of Maryland School of Medicine, Division of Services Research, 737 West Lombard Street, Room 516, Baltimore, MD 21212, USA. Tel: +1 410 706 2490; fax: +1 410 706 0022; e-mail: shimelho@psych.umaryland.edu

© 2009 Lippincott Williams & Wilkins, Inc.