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Depression, bipolar disorder tied to noncommunicable disease risk with HIV
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9th International Workshop on HIV and Aging, September 13-14, 2018, New York
Mark Mascolini
Major depression and/or bipolar affective disorder raised chances of new noncommunicable diseases (NCDs) in a 1998-2015 study of 4140 US adults with HIV infection [1]. Having a mood disorder also inflated the risk of metabolic syndrome in this Vanderbilt University analysis.
When defined as having 2 or more NCDs, multimorbidity has become more frequent in aging HIV populations. A recent study of 22,969 US adults in care for HIV saw almost a tripled rate of multimorbidity, from 8.2% to 22.4%, over the past decade [2]. Major depression and bipolar affective disorder are also prevalent in people with HIV. But Vanderbilt University researchers who conducted the new study noted that the relationship between mood disorder and multimorbidity remains poorly understood.
To address that question, the Vanderbilt team studied HIV-positive adults in care at some point from 1998 through 2015. They identified individuals with a documented mood disorder diagnosis in the year before baseline, defined as 1 year from clinic entry. NCDs included coronary artery disease, chronic kidney disease, cerebrovascular disease, diabetes, dementia, hepatic disease, hyperlipidemia, hypertension, obesity, peripheral vascular disease, and non-AIDS-defining cancers. The investigators defined metabolic syndrome as 3 or more of 4 conditions: hypertension, hyperlipidemia, diabetes, and obesity. They used multivariable competing-risk models (with death as the competing risk) to estimate cumulative incidence functions and adjusted subhazard ratios (sHR) for incident (newly diagnosed) NCDs and multimorbidity.
Among 4140 HIV-positive adults in care, 999 (24%) had a mood disorder, including 649 with depression. People with mood disorder were slightly but significantly older at baseline (40 versus 39 years), more likely to be women (27% versus 22%), more likely to be white (68% versus 48%), and less likely to have a viral load below 400 copies (55% versus 61%). Mood disorder proved more frequent in people who had injected drugs (12% versus 10%) and in those who smoked tobacco currently or in the past (62% versus 47%). Baseline CD4 count and CD4/CD8 ratio did not differ significantly between people with versus without mood disorder.
People with mood disorder proved more likely to have 1 or more NCDs (57% versus 48%) or 2 or more NCDs (27% versus 21%), and they were more likely to die during follow-up (15% versus 13%). The most frequent NCDs were hypertension (40%), obesity (35%), and hyperlipidemia (34%). Among the 999 people with mood disorder, 470 (47%) had NCD multimorbidity, compared with 1219 of 3141 people (39%) without mood disorder.
Having a mood disorder independently raised chances of a new NCD diagnosis 30% (sHR 1.30, 95% confidence interval [CI] 1.07 to 1.58). But the impact of mood disorder on multimorbidity was attenuated for 2 or more NCDs (sHR 1.05, 95% CI 0.87 to 1.26), 3 or more NCDs (sHR 1.13, 95% CI 0.92 to 1.38), or 4 or more NCDs (sHR 1.21, 95% CI 0.94 to 1.55). Having a mood disorder independently boosted chances of metabolic syndrome (sHR 1.29, 95% CI 1.03 to 1.63). That association held true after statistical adjustment for psychiatric medication use. Cox regression analysis determined that mood disorder status did not affect chances of death in people with 2 or more NCDs (HR 1.11, 95% CI 0.78 to 1.59).
The Vanderbilt investigators concluded that HIV-positive people with mood disorder run an increased risk of incident NCDs and may face a higher risk of NCD multimorbidity, particularly metabolic syndrome. They urged "focused prevention and treatment of NCDs" in HIV-positive people with mood disorder.
References
1. Castilho J, Rebeiro P, Shepherd B, et al. Mood disorders and risk of non-communicable disease multi-morbidity among aging adults living with HIV. 9th International Workshop on HIV and Aging, September 13-14, 2018, New York. Abstract 1.
2. Wong C, Gange SJ, Moore RD, et al. Multimorbidity among persons living with human immunodeficiency virus in the United States. Clin Infect Dis. 2018;66:1230-1238.
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