Focused prevention and treatment of noncommunicable diseases may reduce the burden of multimorbidity in people living with HIV (PLWHIV) who have mood disorders and multimorbidity, particularly metabolic syndrome, according to a study recently published in Clinical Science.
In the general population, underlying psychiatric disease has been associated with increased rates of noncommunicable disease, including renal disease, liver disease, cerebrovascular disease, and cardiovascular disease. One potential mechanism of this association is that adults with mood disorders may have higher levels of markers of systemic inflammation and alterations in adaptive immunology. In PLWHIV, the pathogenesis of noncommunicable disease is complex and involves inflammatory, immunologic, pharmacologic, and behavioral mechanisms.
Compared with the general population, bipolar affective disorder and depression are more prevalent in PLWHIV and are associated with an increased mortality risk. Previously, studies among PLWHIV have suggested an association between mood disorders and noncommunicable disease outcomes; specifically, cardiovascular disease. However, it remains unclear whether mood disorders are associated with higher risk for mortality among PLWHIV with multimorbidity. Therefore, this study examined whether prevalent mood disorders (bipolar disorder and depression) are associated with incident noncommunicable disease and multimorbidity in PLWHIV.
In total, 4140 adults with HIV with ³1 year of follow-up were included from 1998 to 2015 from the Vanderbilt University HIV clinic. PLWHIV who had ³1 year of follow-up with the clinic were assessed for various diseases including cardiovascular disease, chronic kidney and liver disease, non-AIDS-defining cancers, metabolic syndrome (categorized as any 3 of: hypertension, obesity, diabetes, or hyperlipidemia), and dementia. Mood disorders that were documented during the first year of care only were included. For risk for noncommunicable disease and multimorbidity with death as a competing risk, cumulative incidence was calculated; mortality risk after multimorbidity was estimated using multivariable Cox models.
Of the included patients, 999 (24%) had documentation of mood disorder diagnoses during their first year in care: 649 (65%) patients had depression and 350 (35%) patients had bipolar affective disorder. In addition, 51% had ³1 noncommunicable disease at baseline, and over the course of the study period, 2588 incident noncommunicable diseases occurred.
Results showed that mood disorders were associated with increased risk for first noncommunicable disease (adjusted subhazard ratio [aSHR], 1.29), incident multimorbidity (aSHR ranging from 1.04 to 1.42), and metabolic syndrome (aSHR, 1.29). During the observation period, 1255 (30%) patients had no prevalent or incident noncommunicable diseases, including 34% of patients without a mood disorder and 25% of patients with a mood disorder.
Prevalent or incident multimorbidity with ³2 noncommunicable diseases occurred in 470 (47%) patients with a baseline mood disorder and in 1219 (39%) patients without mood disorders. The most common among all incident and prevalent noncommunicable disease diagnoses was hypertension, with this diagnosis occurring in 44% of patients with mood disorders and 38% of patients without mood disorders. The most common noncommunicable diseases observed were combinations of the components of metabolic syndrome. Prevalent mood disorders were associated with a 29% increased risk for development of metabolic syndrome; this result was only slightly attenuated when exposure of psychiatric medication was added to the model.
The estimated hazard of death after multimorbidity was 11% higher for patients with a prevalent mood disorder diagnosis than for patients without; however, the confidence intervals were wide, suggesting a strong conclusion cannot be made (aHR, 1.11; 95% CI, 0.79-1.59). In the multivariable model, the following factors were associated with increased risk for mortality after multimorbidity: older age (aHR, 1.65), female sex (aHR, 1.42), and higher log10 HIV RNA (aHR per 1 log10 increase, 1.21). Conversely, the following factors were associated with a decreased risk for death: ever reporting alcohol use (aHR, 0.58) and higher CD4 cell count (aHR per 100 cells/µL increase, 0.85).
Overall, the study authors concluded that, “Mood disorders are a prevalent comorbid condition in [PLWHIV] and may contribute to [noncommunicable disease] risk due to overlapping and synergistic pathophysiology and risk factors.”
Castilho JL, Rebeiro PF, Shepherd BE, et al. Mood disorders and increased risk of noncommunicable disease in adults with HIV. J Acquir Immune Defic Syndr. 2020;83:397-404.