Document Detail


The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals.
MedLine Citation:
PMID:  18290749     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Information regarding the prevalence of mental illness and substance use among HIV-infected patients and the effect of these problems on HIV treatment is needed. We conducted an observational study of patients in the University of Washington (UW) HIV Cohort to determine prevalence rates for mental illness and substance use. Cox regression analyses were used to examine the relationship between mental illness and substance use, pharmacologic treatment for depression/anxiety, and initiation of highly active antiretroviral therapy (HAART) within 9 months of becoming eligible for HAART. Among 1774 patients in the UW HIV cohort during 2004, 63% had a mental illness (including mood, anxiety, psychotic, or personality disorders), 45% had a substance use disorder, and 38% had both. There were 278 patients who met criteria for HAART eligibility. After controlling for other factors, patients with depression and/or anxiety were significantly less likely to initiate HAART compared with patients without a mental illness (hazard ratio [HR] 0.4, p = 0.02). However, patients with depression/anxiety who received antidepressant/antianxiety medications were equally likely to initiate HAART as patients without a mental illness (HR 0.9, p = 0.5). We found that patients with mental illness or substance use disorders receive HAART at lower CD4+ cell counts and higher HIV-1 RNA levels than patients without these disorders. However, HAART initiation among patients who receive treatment for depression/anxiety is associated with no delay. Screening for these disorders in primary care settings and access to appropriate treatment are increasingly important components of providing care to HIV-infected patients.
Authors:
Mary K Tegger; Heidi M Crane; Kenneth A Tapia; Karina K Uldall; Sarah E Holte; Mari M Kitahata
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  AIDS patient care and STDs     Volume:  22     ISSN:  1557-7449     ISO Abbreviation:  AIDS Patient Care STDS     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-14     Completed Date:  2008-03-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607225     Medline TA:  AIDS Patient Care STDS     Country:  United States    
Other Details:
Languages:  eng     Pagination:  233-43     Citation Subset:  IM; X    
Affiliation:
Department of Medicine, University of Washington, Seattle, Washington, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antiretroviral Therapy, Highly Active / statistics & numerical data*
CD4 Lymphocyte Count
Cohort Studies
Depressive Disorder / drug therapy*,  epidemiology
Female
HIV Infections / complications*,  drug therapy,  epidemiology
HIV-1*
Humans
Male
Mental Disorders / complications*,  epidemiology
Prevalence
Proportional Hazards Models
Substance-Related Disorders / classification,  complications*,  epidemiology
Washington / epidemiology
Grant Support
ID/Acronym/Agency:
AI-060464/AI/NIAID NIH HHS; P30 AI-27757/AI/NIAID NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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