Increased Mortality in HIV-Infected Patients with Untreated Psychiatric and Substance Use Disorders
Many HIV-infected patients suffer from co-occurring psychiatric and substance use disorders. Researchers studied health records of 9751 HIV-infected patients in the Kaiser Permanente Northern California health plan from 1996 to 2007 to determine the presence of psychiatric or substance use disorders from ICD-9 codes and to look for records of treatment for these disorders. Relative hazards (RHs) for mortality were calculated and adjusted for a number of factors including CD4 count, HIV viral load, hepatitis C co-infection, and receipt of antiretroviral medications.
- Twenty-five percent of the cohort had a psychiatric disorder, 26% had a substance use disorder, and 12% had both.
- Eighty-four percent of patients with a psychiatric disorder received some treatment, while less than 35% of those with a substance use disorder received treatment.
- Psychiatric and substance use disorders did not have a significant effect on antiretroviral treatment adherence as measured by prescription refill rates.
- Adjusted RHs for mortality were significantly higher for those with psychiatric or substance use disorders, particularly those with both disorders and those who had not received treatment for either disorder.
Comments:
In addition to supporting prior observations that HIV-infected patients with co-occurring psychiatric and/or substance use disorders have a higher mortality risk, this study found lack of treatment for these disorders is associated with even higher risk. Lack of adherence to antiretroviral medications did not appear to account for this discrepancy. These findings reinforce the importance of psychiatric and substance abuse treatment for this vulnerable population.
Darius A. Rastegar, MD
Reference:
DeLorenze GN, Satre DD, Quesenberry CP, et al. Mortality after diagnosis of psychiatric disorders and cooccurring substance use disorders among HIV-infected patients. AIDS Patient Care STDs. 2010;24(11):705–712.