200391 AIDS Patients with Psychiatric Disorders Are As Likely to Recevie Prophylactic Treatment for Pneumocystis Jiroveci Pneumonia (PCP) and Mycobacterium Avium Complex (MAC) as Those Without Psychiatric Disorders

Monday, November 9, 2009

Seth Himelhoch, MD, MPH , Department of Pyschiatry, University of Maryland, Baltimore, MD
Clayton Brown, PhD , Department of Pyschiatry, University of Maryland, Baltimore, MD
Joseph Afful , Department of Pyschiatry, University of Maryland, Baltimore, MD
Geetanjali Chander, MD , Johns Hopkins School of Medicine, Baltimore, MD
P. Todd Korthuis, MD , Oregon Health and Sciences University, Portland, OR
Kelly A. Gebo, MD , Epidemiology Department, Johns Hopkins School of Medicine, Baltimore, MD
Objective: Among those with AIDS we examined whether having a psychiatric disorder is differentially associated with receiving prophylactic treatment for Pneumocystis Jiroveci Pneumonia (PCP) and Mycobacterium Avium Complex (MAC) compared to those without a psychiatric disorder.

Methods: This is a study of medical record data of 2001 patients in HIV care at 5 U.S. HIV sites with on-site mental health services (FY:2005). Separate logistic regression analyses were used to evaluate the adjusted odds of receiving prophylactic treatment for PCP (CD4<200) and MAC (CD4<50). The predictor variable was presence or absence of a psychiatric diagnosis (Serious mental illness (SMI) vs. depression vs. none). These analyses adjusted for demographic factors and injection drug use history.

Results: The majority of the sample was black or Hispanic (77%) and male (72%). Eight percent had a SMI diagnosis and 28% had a depression diagnosis. Seventy-five percent received PCP prophylaxis and 68% received MAC prophylaxis. The unadjusted analysis revealed that those with depression were significantly less likely to receive prophylactic treatment for PCP (OR: 0.67 [0.54-0.84]) and MAC (OR: 0.68 [0.47-0.99]), while those with SMI were as likely to receive prophylactic treatment for PCP or MAC. However, after adjustment, those with depression or SMI were as likely to receive prophylactic treatment for PCP or MAC relative to those with no psychiatric disorders.

Conclusions: Those with psychiatric disorders are as likely to receive prophylactic treatments for PCP and MAC as those without psychiatric disorders. Psychiatric disorders do not appear to be barrier to care.

Learning Objectives:
Identify that people with AIDS and co-occurring psychiatric disorders are as likely to receive Prophylactic Treatment for Pneumocystis Jiroveci Pneumonia (PCP) and Mycobacterium Avium Complex (MAC)compared to those without psychiatric disorders.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an Assistant Professor of Psychiatry at the University of Maryland School of Medicine. I have published research articles and presented on the topic of HIV and Mental disorders in the past.
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.

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See more of: Mental Health