People living with HIV and a comorbid mental health disorder have a higher rate of mortality than those without mental health disorders, according to recent research published in the Journal of the International AIDS Society. Loss of life years may be attributed to factors such as late ART initiation, lower engagement in care, increased risk of suicide and accidental deaths and higher incidences of physical illness.
For this longitudinal cohort study, a team of researchers, including corresponding author Andreas D. Haas, from the University of Bern in Switzerland, used medical records and mortality data from clinical cohorts in South Africa and North America. Participants were followed between the years 2000 and 2021. Disorders such as depression, anxiety, psychotic disorders, and substance use disorders were identified using diagnostic codes. Life-years lost were calculated as the average difference in remaining life expectancy between patients with and without mental disorders, with a cutoff age of 85, due to average life expectancy in both regions.
This study included more than a quarter of a million participants from South Africa and North America, specifically 119,785 participants from South Africa, 48% of whom had a mental health disorder, and 142,044 from North America, 66% of whom were diagnosed with a mental health disorder.
For South African participants, the estimated life years lost were 3.42 years in males and 2.95 years in females.
For North American participants, estimated life years lost were 4.16 in males and 4.64 years in females.
Substance use disorder diagnoses were more prevalent in North America (37%) than in South Africa (1.5%). Depressive and anxiety disorders were the most prevalent disorders in both regions, accounting for approximately 45% of diagnoses in South Africa and 56% of diagnoses in North America.
Mental health disorders such as depression and anxiety were associated with more natural deaths, such as old age. Natural death was calculated as a CD4 count below 200. In both regions, psychotic disorders and substance abuse disorders were associated with greater loss of life. Specifically, psychotic disorders were associated with a 7-to-9-year loss, and substance abuse was associated with a 4-to-10-year loss.
Deaths associated with mental disorders in North America may be explained by higher rates of substance abuse compared with South Africa.
“Among people living with HIV, the impact of mental health disorders on mortality is of particular concern because both HIV and mental illness can act as risk factors for physical comorbidities, such as diabetes or cardiovascular disease,” Haas and the team write in the study. “Improved management of HIV and physical comorbidities among PWH affected by mental health disorders may enhance their prognosis.”
Disorders such as depression may also make it difficult for HIV patients to make it to their appointments or adhere to treatments, factors that are essential for long-term viral suppression and survival.
Individuals with mental health disorders already have a lower life expectancy than the general population, with a reduced life expectancy ranging from 1 to 15 years less, according to the study. In addition, the prevalence of mental health disorders is also higher in people living with HIV compared to the general population.