HIV patients with psychiatric disorders are less likely to discontinue HAART

Seth Himelhoch, Clayton H. Brown, James Walkup, Geetanjali Chander, P. Todd Korthius, Joseph Afful, Kelly A. Gebo

Publication Date: 08/24/2009

OBJECTIVE: We examined whether having a psychiatric disorder among HIV-infected individuals is associated with differential rates of discontinuation of HAART and whether the number of mental health visits impact these rates. DESIGN: This longitudinal study (fiscal year: 2000-2005) used discrete time survival analysis to evaluate time to discontinuation of HAART. The predictor variable was presence of a psychiatric diagnosis (serious mental illness versus depressive disorders versus none). SETTING: Five United States outpatient HIV sites affiliated with the HIV Research Network. PATIENTS: The sample consisted of 4989 patients. The majority was nonwhite (74.0%) and men (71.3%); 24.8% were diagnosed with a depressive disorder, and 9% were diagnosed with serious mental illness. MAIN OUTCOME MEASURES: Time to discontinuation of HAART adjusting for demographic factors, injection drug use history, and nadir CD4 cell count. RESULTS: Relative to those with no psychiatric disorders, the hazard probability for discontinuation of HAART was significantly lower in the first and second years among those with SMI [adjusted odds ratio: first year, 0.57 (0.47-0.69); second year, 0.68 (0.52-0.89)] and in the first year among those with depressive disorders [adjusted odds ratio: first year, 0.61 (0.54-0.69)]. The hazard probabilities did not significantly differ among diagnostic groups in subsequent years. Among those with psychiatric diagnoses, those with six or more mental health visits in a year were significantly less likely to discontinue HAART compared with patients with no mental health visits. CONCLUSION: Individuals with psychiatric disorders were significantly less likely to discontinue HAART in the first and second years of treatment. Mental health visits are associated with decreased risk of discontinuing HAART.