Mortality under plausible interventions on antiretroviral treatment and depression in HIV-infected women

an application of the parametric g-formula

WIHS Investigators

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)783-789.e2
JournalAnnals of Epidemiology
Volume27
Issue number12
DOIs
StatePublished - Dec 1 2017

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HIV
Mortality
Therapeutics

Keywords

  • Antiretroviral therapy
  • Cohort studies
  • Depression
  • HIV
  • Mortality
  • Survival analysis

ASJC Scopus subject areas

  • Epidemiology

Cite this

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

In: Annals of Epidemiology, Vol. 27, No. 12, 01.12.2017, p. 783-789.e2.

Research output: Contribution to journalArticle

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title = "Mortality under plausible interventions on antiretroviral treatment and depression in HIV-infected women: an application of the parametric g-formula",
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-na{\"i}ve 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",
author = "{WIHS Investigators} and Lesko, {Catherine R.} and Todd, {Jonathan V.} and Cole, {Stephen R.} and Andrew Edmonds and Pence, {Brian W.} and Edwards, {Jessie K.} and Mack, {Wendy J.} and Peter Bacchetti and Anna Rubtsova and Gange, {Stephen J.} and Adimora, {Adaora A.} and Michael Saag and Kempf, {Mirjam Colette} and Deborah Konkle-Parker and Ighovwerha Ofotokun and Gina Wingood and Kathryn Anastos and Howard Minkoff and Deborah Gustafson and Mardge Cohen and Audrey French and Mary Young and Seble Kassaye and Margaret Fischl and Lisa Metsch and Adaora Adimora and Ruth Greenblatt and Bradley Aouizerat and Phyllis Tien and Stephen Gange and Elizabeth Golub and Joel Milam",
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TY - JOUR

T1 - Mortality under plausible interventions on antiretroviral treatment and depression in HIV-infected women

T2 - an application of the parametric g-formula

AU - WIHS Investigators

AU - Lesko, Catherine R.

AU - Todd, Jonathan V.

AU - Cole, Stephen R.

AU - Edmonds, Andrew

AU - Pence, Brian W.

AU - Edwards, Jessie K.

AU - Mack, Wendy J.

AU - Bacchetti, Peter

AU - Rubtsova, Anna

AU - Gange, Stephen J.

AU - Adimora, Adaora A.

AU - Saag, Michael

AU - Kempf, Mirjam Colette

AU - Konkle-Parker, Deborah

AU - Ofotokun, Ighovwerha

AU - Wingood, Gina

AU - Anastos, Kathryn

AU - Minkoff, Howard

AU - Gustafson, Deborah

AU - Cohen, Mardge

AU - French, Audrey

AU - Young, Mary

AU - Kassaye, Seble

AU - Fischl, Margaret

AU - Metsch, Lisa

AU - Adimora, Adaora

AU - Greenblatt, Ruth

AU - Aouizerat, Bradley

AU - Tien, Phyllis

AU - Gange, Stephen

AU - Golub, Elizabeth

AU - Milam, Joel

PY - 2017/12/1

Y1 - 2017/12/1

N2 - 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.

AB - 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.

KW - Antiretroviral therapy

KW - Cohort studies

KW - Depression

KW - HIV

KW - Mortality

KW - Survival analysis

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DO - 10.1016/j.annepidem.2017.08.021

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SP - 783-789.e2

JO - Annals of Epidemiology

JF - Annals of Epidemiology

SN - 1047-2797

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