Health Outcomes of HIV-Infected People with Mental Illness.
Improving outcomes for people with HIV and mental illness will be critical to meeting the goals of the US National HIV/AIDS Strategy. In a retrospective analysis of the 2008-2010 cycles of the locally representative Philadelphia Medical Monitoring Project, we compared the proportions of HIV-infected adults with and without mental illness: (1) retained in care (≥2 primary HIV visits separated by ≥90 days in a 12-month period); (2) prescribed antiretroviral therapy (ART) at any point in a 12-month period; and (3) virally suppressed (HIV-1 RNA ≤200 copies/mL at the last measure in the 12-month period). Multivariable regression assessed associations between mental illness and the outcomes, adjusting for age, gender, race/ethnicity, insurance, alcohol abuse, injection drug use, CD4 count, and calendar year. Of 730 HIV-infected persons, representative of 9409 persons in care for HIV in Philadelphia, 49.0 % had mental illness. In adjusted analyses, there were no significant differences in retention (91.3 vs. 90.3 %; AOR 1.30, 95 % CI 0.63-2.56) and prescription of ART (83.2 vs. 88.7 %; AOR 0.79, 95 % CI 0.49-1.25) between those with and without mental illness. However, mentally ill patients were less likely to achieve viral suppression than those without mental illness (65.9 vs. 74.4 %; AOR 0.64, 95 % CI 0.46-0.90). These findings argue for the need to optimize ART adherence in this population.
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 1021 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA, byehia@upenn.edu.
Baligh R
BR
Yehia
Alisa J
AJ
Stephens-Shield
Florence
F
Momplaisir
Lynne
L
Taylor
Robert
R
Gross
Benoit
B
Dubé
Karen
K
Glanz
Kathleen A
KA
Brady
D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects*; D055815:Young Adult