title: Relationship between ever reporting depressive symptoms and all-cause mortality in a cohort of HIV-infected adults in routine care.
abstract: The aim of this study was to assess whether ever reporting depressive symptoms affects mortality in the modern HIV treatment era.
  
  
  
  A cohort study of HIV-infected adults in routine clinical care at seven sites in the USA.
  
  
  
  We examined the effect of ever reporting depressive symptoms on all-cause mortality using data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We included individuals with at least one depression measure between 2005 and 2014. Depressive symptoms were measured with the Patient Health Questionnaire (PHQ)-9. We used weighted Kaplan-Meier curves and marginal structural Cox models with inverse probability weights to estimate the effect of ever reporting depressive symptoms (PHQ-9 ≥10) on all-cause mortality.
  
  
  
  A total of 10 895 individuals were included. Participants were followed for a median of 3.1 years (35 621 total person-years). There were 491 (4.5%) deaths during the follow-up period (crude incidence rate 13.8/1000 person-years). At baseline, 28% of the population reported depressive symptoms. In the weighted analysis, there was no evidence that ever reporting depressive symptoms increased the hazard of all-cause mortality (hazard ratio 0.82, 95% confidence interval 0.55-1.24).
  
  
  
  In a large cohort of HIV-infected adults in care in the modern treatment era, we observed no evidence that ever reporting depressive symptoms increased the likelihood of all-cause mortality, controlling for a range of time-varying factors. Antiretroviral therapy that is increasingly robust to moderate adherence and improved access to depression treatment may help to explain changes in the relationship between depressive symptoms and mortality in the modern treatment era.
authors.affiliation: aDepartment of Epidemiology, University of North Carolina, Chapel Hill, North Carolina bDepartment of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland cDepartments of Behavioral & Social Sciences and Epidemiology School of Public Health dDepartment of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island eThe Fenway Institute, Fenway Health, Boston, Massachusetts fDepartment of Medicine, School of Medicine, University of California, San Diego, San Diego, California gDivision of Infectious Diseases hDepartment of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina iHIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco, San Francisco, California jDepartment of Medicine, School of Medicine, University of Washington, Seattle, Washington kDepartment of Medicine and UAB Center for AIDS Research, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Bengtson
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
authors.forename: Richard
authors.initials: R
authors.lastname: Moore
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
authors.forename: William Christopher
authors.initials: WC
authors.lastname: Mathews
authors.forename: Amy
authors.initials: A
authors.lastname: Heine
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.forename: Katerina
authors.initials: K
authors.lastname: Christopoulos
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology