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Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality Among HIV-Infected Women.

Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality Among HIV-Infected Women.
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Todd JV, Cole SR, Pence BW, Lesko CR, Bacchetti P, Cohen MH, Feaster DJ, Gange S, Griswold ME, Mack W, Rubtsova A, Wang C, Weedon J, Anastos K, Adimora AA,


Todd JV, Cole SR, Pence BW, Lesko CR, Bacchetti P, Cohen MH, Feaster DJ, Gange S, Griswold ME, Mack W, Rubtsova A, Wang C, Weedon J, Anastos K, Adimora AA, (click to view)

Todd JV, Cole SR, Pence BW, Lesko CR, Bacchetti P, Cohen MH, Feaster DJ, Gange S, Griswold ME, Mack W, Rubtsova A, Wang C, Weedon J, Anastos K, Adimora AA,

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American journal of epidemiology 2017 04 18() 1-10 doi 10.1093/aje/kww192

Abstract

Depression affects up to 30% of human immunodeficiency virus (HIV)-infected individuals. We estimated joint effects of antiretroviral therapy (ART) initiation and depressive symptoms on time to death using a joint marginal structural model and data from a cohort of HIV-infected women from the Women’s Interagency HIV Study (conducted in the United States) from 1998-2011. Among 848 women contributing 6,721 years of follow-up, 194 participants died during follow-up, resulting in a crude mortality rate of 2.9 per 100 women-years. Cumulative mortality curves indicated greatest mortality for women who reported depressive symptoms and had not initiated ART. The hazard ratio for depressive symptoms was 3.38 (95% confidence interval (CI): 2.15, 5.33) and for ART was 0.47 (95% CI: 0.31, 0.70). Using a reference category of women without depressive symptoms who had initiated ART, the hazard ratio for women with depressive symptoms who had initiated ART was 3.60 (95% CI: 2.02, 6.43). For women without depressive symptoms who had not started ART, the hazard ratio was 2.36 (95% CI: 1.16, 4.81). Among women reporting depressive symptoms who had not started ART, the hazard ratio was 7.47 (95% CI: 3.91, 14.3). We found a protective effect of ART initiation on mortality, as well as a harmful effect of depressive symptoms, in a cohort of HIV-infected women.

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