Pharmacologic Treatment of Psychiatric Disorders and Time with Unsuppressed HIV Viral Load in a Clinical HIV Cohort
Document Type
Journal Article
Publication Date
11-1-2019
Journal
Journal of Acquired Immune Deficiency Syndromes
Volume
82
Issue
3
DOI
10.1097/QAI.0000000000002138
Keywords
anxiety disorders; HIV infection; mood disorders; pharmacologic therapy; psychotic disorders; stress disorders
Abstract
© 2019 Wolters Kluwer Health, Inc. All rights reserved. Objective:To evaluate associations of mood, anxiety, stress-/trauma-related, and psychotic disorders, both treated and untreated, with duration of unsuppressed HIV viral load (VL) among persons living with HIV (PLWH).Setting:The DC Cohort, an observational clinical cohort of PLWH followed from 2011 to 2018 at 14 sites in Washington, DC.Methods:Among PLWH ≥18 years old who received primary care at their HIV clinic, we determined in a time-updated manner whether participants had diagnoses and pharmacologic prescriptions for mood, anxiety, stress-/trauma-related, and/or psychotic disorders. Associations between psychiatric disorders/treatments and the proportion of subsequent days with VL ≥200 copies/mL were assessed using multivariable Poisson regression with generalized estimating equations.Results:Among 5904 participants (median age 51; 70% men; 82% Black), 45% had ≥1 psychiatric disorder, including 38% with mood disorders (50% treated), 18% with anxiety or stress-/trauma-related disorders (64% treated), and 4% with psychotic disorders (52% treated). Untreated major depressive disorder (adjusted rate ratio = 1.17; 95% confidence interval: 1.00 to 1.37), untreated other/unspecified depressive disorder (1.23; 1.01 to 1.49), untreated bipolar disorder (1.39; 1.15 to 1.69), and treated bipolar disorder (1.25; 1.02 to 1.53) (vs. no mood disorder) predicted more time with VL ≥200 copies/mL. Treated anxiety disorders (vs. no anxiety disorder) predicted less time (0.78; 0.62 to 0.99). Associations were weaker and nonsignificant for treated depressive disorders (vs. no mood disorder) and untreated anxiety disorders (vs. no anxiety disorder).Conclusions:PLWH with depressive and bipolar disorders, particularly when untreated, spent more time with unsuppressed VL than PLWH without a mood disorder. Treatment of mood disorders may be important for promoting sustained viral suppression.
APA Citation
Levy, M., Monroe, A., Horberg, M., Benator, D., Molock, S., Doshi, R., Powers Happ, L., & Castel, A. (2019). Pharmacologic Treatment of Psychiatric Disorders and Time with Unsuppressed HIV Viral Load in a Clinical HIV Cohort. Journal of Acquired Immune Deficiency Syndromes, 82 (3). http://dx.doi.org/10.1097/QAI.0000000000002138
