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HIV-positive gay and bisexual men have increased risk of hospitalisation with anxiety and mood disorders, a risk factor for later mortality
Michael Carter, 2016-09-07 07:50:00
and bisexual men are almost ten times more likely to be hospitalised because of
mood and anxiety disorders than men in the general population, according to
Australian research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes.
The research also
showed that gay and bisexual men (GBM) with HIV were significantly more likely
to be admitted to hospital with anxiety and mood disorders (AMDs) compared to
matched HIV-negative gay and bisexual men. Hospitalisation due to AMDs was
associated with an increased mortality risk, and there was an association
between substance abuse and mortality among hospitalised patients.
“Substance use was
listed as the cause of death in 42% of deaths in the HIV-infected cohort previously
hospitalised for AMDs,” note the authors. “This supports previous literature
which has documented a high frequency of comorbid psychiatric and drug
dependence disorders in HIV-infected and GBM cohorts.”
needs to be devoted to the identification and treatment of AMDs in gay and
bisexual men, especially those with HIV, the authors recommend.
It is already well
known that there is a high prevalence of mental health problems in the
HIV-infected population. Research investigating the prevalence of AMDs has
yielded varying results, probably due to how these mental health problems are
assessed and differences in the risk profiles of particular populations.
Sydney, Australia, designed a study to address the limitations of this earlier
research. They focused on gay and bisexual men, a group known to have a higher
risk of mental health problems compared to the general population. They
examined the relationship between HIV status (HIV-positive vs. HIV-negative)
and hospitalisation due to AMDs. They also assessed whether admission to
hospital with this type of mental health problem was predictive of death, and
whether this risk differed between HIV-positive and HIV-negative men.
from two cohorts, one consisting of men with HIV (557 individuals), the other
HIV-negative men (1882 individuals). Both cohorts were recruited in Sydney. The
HIV-positive cohort was recruited 1998-2006, whereas recruitment to the
HIV-negative cohort took place between 2001-04. Both cohorts consisted
exclusively of men who identified as gay or bisexual. Follow-up was to the end
Information on hospital
admissions with AMDs was obtained from hospital records, HIV administrative
records and death registries.
HIV-positive and HIV-negative men had a median age of 41 years and 35 years,
respectively. Approximately two-thirds of the men with HIV and three-quarters
of HIV-negative men had a college education. Illicit drug use was very common,
with over 80% of men in both cohorts reporting their use within the previous six
months. Prevalence of psychological distress was massively higher among HIV-positive
men compared to HIV-negative men (60% vs. 1%).
Of the men with
HIV, 74% reported use of combination antiretroviral therapy (cART), 45% had a
recent CD4 count above 500 cells/mm3 and 77% were diagnosed in the
There were 300
hospital admissions due to AMDs. A significantly greater proportion of
HIV-positive men were admitted to hospital with AMDs than HIV-negative men (n =
85, 15% vs. n = 72, 5%; p < 0.001).
rates with a primary AMD diagnosis were 9.7 times higher among HIV-positive men
compared with rates in the adult male Australian population.
with hospitalisation included having HIV (IRR = 2.49; 95% CI, 1.47-4.21),
identifying as bisexual rather than gay/queer/homosexual (IRR = 5.24; 95% CI,
2.34-11.74), being religious (IRR = 2.21; 95% CI, 1.40-3.49), having previously
sought support for mental health issues (IRR = 4.25; 95% CI, 2.96-8.27) and
being a smoker (IRR = 1.94; 95% CI, 1.22-3.08).
patients who drank small amounts of alcohol were less likely to have an
admission compared to non-drinkers.
In the HIV cohort,
hospitalisation was related to previous dementia (IRR = 3.08; 95% CI,
1.78-5.30), more recent diagnosis with HIV (p = 0.025) and a low baseline CD4
showed that 19 of the patients hospitalised with AMDs died, four of whom were
for other risk factors, hospitalisation with AMDs was associated with a more
than five-fold increase in mortality risk (HR = 5.48; 95% CI, 1.88-8.05).
Mortality risk did not differ by HIV status. Alcohol abuse or liver failure was
listed as a primary of secondary cause of death in 42% of HIV-positive patients
hospitalised for AMDs.
highlights the importance of providing more effective strategies to identify
and treat AMDs in HIV-infected GBM,” conclude the authors. “Our research
suggests the importance of further examination and joint effects of substance
use, neurocognitive decline and AMDs on health outcomes in HIV-infected individuals.”