171132 Does Having a Mental Disorder Impact Discontinuation of Highly Active Antiretroviral Therapy: A Discrete Time Survival Analysis

Monday, October 27, 2008: 2:48 PM

Seth Himelhoch, MD, MPH , Department of Pyschiatry, University of Maryland, Baltimore, MD
Clayton Brown, PhD , Department of Pyschiatry, University of Maryland, Baltimore, MD
James Walkup, PhD , Graduate School of Applied and Professional Psychology at Rutgers University, Piscataway, NJ
Geetanjali Chander, MD , Johns Hopkins School of Medicine, Baltimore, MD
Joseph Afful , Department of Pyschiatry, University of Maryland, Baltimore, MD
Kelly A. Gebo, MD , Epidemiology Department, Johns Hopkins School of Medicine, Baltimore, MD
Objective: Among HIV infected individuals we examined whether having a co-occurring psychiatric disorder is associated with differential rates of discontinuation of HAART or clinical care relative to those without a psychiatric disorder.

Methods: This is a study of medical record data of 5,946 patients in HIV care at 5 U.S. HIV sites with on-site mental health services (FY:2001-2006). Discrete time survival analysis was used to evaluate time from initiating HAART to discontinuation of HAART or clinical care. The predictor variable was presence or absence of a psychiatric diagnosis (Serious mental illness (SMI) vs. depression/anxiety vs. none). The analysis adjusted for demographic factors, injection drug use history and nadir CD4 count.

Results: The majority of the sample was black or Hispanic (73.7%) and male (71.5%). Eight percent had a diagnosis of SMI and 25.1% had a diagnosis of depression/anxiety. Relative to those with no psychiatric disorders, the Hazard Probability for discontinuation of HAART or clinical care was significantly lower (p <0.05) in the second and third years following initiation of HAART among those with SMI (Adjusted Hazard Ratios (AHR): Year 2, 0.56; Year 3, 0.67) and among those with depression/anxiety (AHR's: Year 2, 0.62; Year 3, 0.86). The probabilities did not significantly differ in years 4 and 5 among diagnostic groups.

Conclusions: Among those who initiate HAART, individuals with psychiatric disorders were significantly less likely to discontinue HAART or clinical care in years 2-3 relative to those without psychiatric disorders. Psychiatric disorders should not be considered a barrier to HIV treatment.

Learning Objectives:
Recognize that those with psychiatric disorders are less likely to discontinue highly active retroviral therapy or discontinue clinical care in the early years of treatment compared to those without psychiatric disorders.

Keywords: HIV/AIDS, Mental Illness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: PhD in Biostatistics. PhD program funded by NIMH training grant. Multiple mental health service and clinical psychiatry articles published. All research efforts have been in mental health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Mental Health Services Research
See more of: Mental Health