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Unhealthy drinking, cigarette use, depression associated with higher mortality risk among PLWH
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Unhealthy drinking, cigarette use and depression are common among people living with HIV and are associated with higher mortality risk, according to a recent study. The findings underscore the critical need to screen for and treat these conditions, researchers said.
“Globally, cigarette use and unhealthy alcohol consumption result in 7 million and 3 million deaths, respectively, each year. Three hundred million people in the world live with depression. Cigarette use (20% to 24%), unhealthy alcohol use (17% to 25%), and depression (7%) are prevalent in the general population and are attributed to a combined $600 billion in health care costs and lost productivity in the United States,” Natalie E. Chichetto, PhD, a postdoctoral research fellow at the Vanderbilt University Medical Center, and colleagues wrote. “Among persons living with HIV (PLWH), the prevalence of smoking (20% former; 44% current), unhealthy alcohol use (25%) including alcohol use disorder (10%), and depression (18% to 81%) is high. Individually, cigarette use, unhealthy alcohol consumption, and depression are associated with an increased risk of death. However, the extent to which these conditions cluster — known as a syndemic — in this population is unclear.”
Researchers evaluated a prospective, observational cohort of 6,721 PLWH and matched uninfected veterans from the Veterans Aging Cohort Study who were enrolled in 2002 and followed through 2015. The researchers estimated the prevalence of veterans who had more than one of the syndemic conditions, the risk for death associated with the number of conditions among PLWH, and whether HIV status affected the mortality risk associated with the number of conditions.
Results of the study showed that fewer than 10% of participants had no conditions, 25.6% had one, 51% had two and 15% had all three. The study also showed that there were 1,747 deaths, 61.9% of which were among PLWH during follow-up. Overall, age-adjusted mortality rates per 1,000 person-years increased with the greater number of conditions — for example, 12 for no conditions, 21.2 for one condition, 30.4 for two conditions and 36.3 for three conditions. According to the study, PLWH with all three conditions had an adjusted HR of mortality that was 36% higher compared with uninfected participants with three conditions (95% CI, 1.07-1.72).
“This association persisted after controlling for important cofounders, including general health status and HIV progression,” the researchers concluded. “These findings support aggressive screening and treatment efforts for unhealthy alcohol use, cigarette use, and depression as a syndemic and, when possible, adopting effective parsimonious treatments. Future research should focus on the longitudinal effects of this syndemic on morbidity and mortality, as well as investigation of other associated conditions such as poly-substance use.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
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