HIV-positive GBM more likely to be admitted with AMDs

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HIV-positive gay and bisexual men are almost 10 times more likely to be hospitalised because of anxiety and mood disorders (AMD) than men in the general population, according to Australian research.

The research also showed that gay and bisexual men with HIV were significantly more likely to be admitted to hospital with anxiety and mood disorders (AMDs) compared to matched HIV-negative gay and bisexual men. Hospitalisation due to AMDs was associated with an increased mortality risk, and there was an association between substance abuse and mortality among hospitalised patients.

“Substance use was listed as the cause of death in 42% of deaths in the HIV-infected cohort previously hospitalised for AMDs,” note the authors led by Cecelia Moore at the Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia. “This supports previous literature which has documented a high frequency of comorbid psychiatric and drug dependence disorders in HIV-infected and GBM (gay and bisexual men) cohorts.”

More attention needs to be devoted to the identification and treatment of AMDs in gay and bisexual men, especially those with HIV, the authors recommend.

It is already well known that there is a high prevalence of mental health problems in people living with HIV. Research investigating the prevalence of AMDs has yielded varying results, probably due to how these mental health problems are assessed and differences in the risk profiles of particular populations.

Investigators designed a study to address the limitations of this earlier research. They focused on gay and bisexual men, a group known to have a higher risk of mental health problems compared to the general population. They examined the relationship between HIV status (HIV-positive vs. HIV-negative) and hospitalisation due to AMDs. They also assessed whether admission to hospital with this type of mental health problem was predictive of death, and whether this risk differed between HIV-positive and HIV-negative men.

Participants came from two cohorts, one consisting of men with HIV (557 individuals), the other HIV-negative men (1882 individuals). Both cohorts were recruited in Sydney. The HIV-positive cohort was recruited between 1998 and 2006, whereas recruitment to the HIV-negative cohort took place between 2001 and 2004. Both cohorts consisted exclusively of men who identified as gay or bisexual. Follow-up was to the end of 2007. Information on hospital admissions with AMDs was obtained from hospital records, HIV administrative records and death registries.

At baseline, HIV-positive and HIV-negative men had a median age of 41 years and 35 years, respectively. Approximately two-thirds of the men with HIV and three-quarters of HIV-negative men had a college education. Illicit drug use was very common, with over 80% of men in both cohorts reporting their use within the previous six months. Prevalence of psychological distress was massively higher among HIV-positive men compared to HIV-negative men (60% vs. 1%).

Of the men with HIV, 74% reported use of combination antiretroviral therapy (cART), 45% had a recent CD4 count above 500 cells/mm3 and 77% were diagnosed in the pre-cART era.

There were 300 hospital admissions due to AMDs. A significantly greater proportion of HIV-positive men were admitted to hospital with AMDs than HIV-negative men (n = 85, 15% vs. n = 72, 5%; p < 0.001).

Hospitalisation rates with a primary AMD diagnosis were 9.7 times higher among HIV-positive men compared with rates in the adult male Australian population.

Factors associated with hospitalisation included having HIV (IRR = 2.49; 95% CI, 1.47-4.21), identifying as bisexual rather than gay/queer/homosexual (IRR = 5.24; 95% CI, 2.34-11.74), being religious (IRR = 2.21; 95% CI, 1.40-3.49), having previously sought support for mental health issues (IRR = 4.25; 95% CI, 2.96-8.27) and being a smoker (IRR = 1.94; 95% CI, 1.22-3.08).

Interestingly, individuals who drank small amounts of alcohol were less likely to have an admission compared to non-drinkers. In the HIV cohort, hospitalisation was related to previous dementia (IRR = 3.08; 95% CI, 1.78-5.30), more recent diagnosis with HIV (p = 0.025) and a low baseline CD4 cell count.

Mortality analysis showed that 19 people hospitalised with AMDs died, four of whom were HIV-positive.

After adjustment for other risk factors, hospitalisation with AMDs was associated with a more than fivefold increase in mortality risk (HR = 5.48; 95% CI, 1.88-8.05). Mortality risk did not differ by HIV status. Alcohol abuse or liver failure was listed as a primary or secondary cause of death in 42% of HIV-positive people hospitalised for AMDs.

“This research highlights the importance of providing more effective strategies to identify and treat AMDs in HIV-infected GBM,” conclude the authors. “Our research suggests the importance of further examination and joint effects of substance use, neuro-cognitive decline and AMDs on health outcomes in HIV-infected individuals.”

Abstract
Background: Prevalence of anxiety and mood disorders (AMDs) in HIV-infected individuals has varied widely due to the variety of measurements used and differences in risk factor profiles between different populations. We aimed to examine the relationship between HIV-status and hospitalisation for AMDs in GBM.
Design: and Methods: HIV-infected (n=557) and -uninfected (n=1325) GBM recruited in Sydney, Australia were probabilistically linked to their hospital admissions and death notifications (2000-2012). Random-effects Poisson models were used to assess risk factors for hospitalisation. Cox regression methods were used to assess risk factors for mortality.
Results: We observed 300 hospitalisations for AMDs in 15.3% of HIV-infected and 181 in 5.4% of -uninfected participants. Being infected with HIV was associated with a 2 and a half fold increase in risk of hospitalisation for AMDs in GBM. Other risk factors in the HIV-infected cohort included previous hospitalisation for HIV-related dementia, a more recent HIV-diagnosis and a CD4 T-cell count above 350/mm3. Being hospitalised for an AMD was associated with a 5 and a half fold increased risk of mortality, this association did not differ by HIV status. An association between substance use and mortality was observed in individuals hospitalised for AMDs.
Conclusions: There is a need to provide more effective strategies to identify and treat AMDs in HIV-infected GBM. This research highlights the importance of further examination of the effects of substance use, neurocognitive decline and AMDs on the health of HIV-infected individuals.

Authors
Moore, Cecilia L; Grulich, Andrew E; Prestage, Garrett; Gidding, Heather F; Jin, Fengyi; Petoumenos, Kathy; Zablotska, Iryna B; Poynten, I Mary; Mao, Limin; Law, Matthew G; Amin, Janaki

Aidsmap material
Journal of Acquired Immune Deficiency Syndromes abstract


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