HIV patients with psychiatric disorders are less likely to discontinue HAART

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Objective:We examined whether having a psychiatric disorder among HIV-infected individuals is associated with differential rates of discontinuation of HAART and whether the number of mental health visits impact these rates.Design:This longitudinal study (fiscal year: 2000–2005) used discrete time survival analysis to evaluate time to discontinuation of HAART. The predictor variable was presence of a psychiatric diagnosis (serious mental illness versus depressive disorders versus none).Setting:Five United States outpatient HIV sites affiliated with the HIV Research Network.Patients:The sample consisted of 4989 patients. The majority was nonwhite (74.0%) and men (71.3%); 24.8% were diagnosed with a depressive disorder, and 9% were diagnosed with serious mental illness.Main outcome measures:Time to discontinuation of HAART adjusting for demographic factors, injection drug use history, and nadir CD4 cell count.Results:Relative to those with no psychiatric disorders, the hazard probability for discontinuation of HAART was significantly lower in the first and second years among those with SMI [adjusted odds ratio: first year, 0.57 (0.47–0.69); second year, 0.68 (0.52–0.89)] and in the first year among those with depressive disorders [adjusted odds ratio: first year, 0.61 (0.54–0.69)]. The hazard probabilities did not significantly differ among diagnostic groups in subsequent years. Among those with psychiatric diagnoses, those with six or more mental health visits in a year were significantly less likely to discontinue HAART compared with patients with no mental health visits.Conclusion:Individuals with psychiatric disorders were significantly less likely to discontinue HAART in the first and second years of treatment. Mental health visits are associated with decreased risk of discontinuing HAART.

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