title: Mental health disorders and the risk of AIDS-defining illness and death in HIV-infected veterans.
abstract: OBJECTIVE
  Mental health comorbidities are common in HIV-infected veterans and can impact clinical outcomes for HIV. We examined the impact of mental health diagnoses on progression to AIDS-defining illness (ADI) and death in a large cohort of HIV-infected veterans who accessed care between 2001 and 2006.
  
  
  METHODS
  Retrospective cohort study using the national Veterans Health Administration (VHA) HIV Clinical Case Registry.
  
  
  METHODS
  We identified HIV-infected veterans initiating combination antiretroviral therapy (cART) within the VHA between 2000 and 2006. The prevalences of the following mental health diagnoses were examined: schizophrenia, bipolar disorder, depression, anxiety, and substance use disorder. Cox proportional hazards models were constructed to examine the relationship between mental health conditions and two outcomes, all-cause mortality and ADI. Models were computed before and after adjusting for confounding factors including age, race, baseline CD4 cell count, comorbidities and cART adherence.
  
  
  RESULTS
  Among 9003 veterans receiving cART, 31% had no mental health diagnosis. Age, race, baseline comorbidity score, CD4, and cART adherence were associated with shorter time to ADI or death. All-cause mortality was more likely among veterans with schizophrenia, bipolar disorder and substance use, and ADI was more likely to occur among veterans with substance use disorder.
  
  
  CONCLUSIONS
  Our results demonstrate the high prevalence of mental health diagnoses among HIV-infected veterans. In the era of highly active antiretroviral therapy, presence of psychiatric diagnoses impacted survival and development of ADI. More aggressive measures addressing substance abuse and severe mental illness in HIV-infected veterans are necessary.
authors.affiliation: St. Louis VA Medical Center, Missouri, USA. diana.nurutdinova@va.gov
authors.forename: Diana
authors.initials: D
authors.lastname: Nurutdinova
authors.forename: Timothy
authors.initials: T
authors.lastname: Chrusciel
authors.forename: Angelique
authors.initials: A
authors.lastname: Zeringue
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Scherrer
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Al-Aly
authors.forename: Jay R
authors.initials: JR
authors.lastname: McDonald
authors.forename: Edgar T
authors.initials: ET
authors.lastname: Overton
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality; D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D058014:Veterans Health