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So-Armah K, Gupta SK, Kundu S, Stewart JC, Goulet JL, Butt AA, Sico JJ, Marconi VC, Crystal S, Rodriguez-Barradas MC, Budoff M, Gibert CL, Chang CC, Bedimo R, Freiberg MS. Depression and all-cause mortality risk in HIV-infected and HIV-uninfected US veterans: a cohort study. HIV Med 2019; 20:317-329. [PMID: 30924577 DOI: 10.1111/hiv.12726] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The contribution of depression to mortality in adults with and without HIV infection is unclear. We hypothesized that depression increases mortality risk and that this association is stronger among those with HIV infection. METHODS Veterans Aging Cohort Study (VACS) data were analysed from the first clinic visit on or after 1 April 2003 (baseline) to 30 September 2015. Depression definitions were: (1) major depressive disorder defined using International Classification of Diseases, Ninth Revision (ICD-9) codes; (2) depressive symptoms defined as Patient Health Questionnaire (PHQ)-9 scores ≥ 10. The outcome was all-cause mortality. Covariates were demographics, comorbid conditions and health behaviours. RESULTS Among 129 140 eligible participants, 30% had HIV infection, 16% had a major depressive disorder diagnosis, and 24% died over a median follow-up time of 11 years. The death rate was 25.3 [95% confidence interval (CI) 25.0-25.6] deaths per 1000 person-years. Major depressive disorder was associated with mortality [hazard ratio (HR) 1.04; 95% CI 1.01, 1.07]. This association was modified by HIV status (interaction P-value = 0.02). In HIV-stratified analyses, depression was significantly associated with mortality among HIV-uninfected veterans but not among those with HIV infection. Among those with PHQ-9 data (n = 7372), 50% had HIV infection, 22% had PHQ-9 scores ≥ 10, and 28% died over a median follow-up time of 12 years. The death rate was 27.3 (95% CI 26.1-28.5) per 1000 person-years. Depressive symptoms were associated with mortality (HR 1.16; 95% CI 1.04, 1.28). This association was modified by HIV status (interaction P-value = 0.05). In HIV-stratified analyses, depressive symptoms were significantly associated with mortality among veterans with HIV infection but not among those without HIV infection. CONCLUSIONS Depression was associated with all-cause mortality. This association was modified by HIV status and method of depression ascertainment.
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Affiliation(s)
- K So-Armah
- Boston University School of Medicine, Boston, MA, USA
| | - S K Gupta
- Indiana University School of Medicine, Indianapolis (IUPUI), Indianapolis, IN, USA
| | - S Kundu
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - J C Stewart
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - J L Goulet
- VA Connecticut Healthcare System, West Haven, CT, USA.,Yale University School of Medicine, New Haven, CT, USA
| | - A A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Weill Cornell Medical College, New York, NY, USA.,Weill Cornell Medical College, Doha, Qatar.,Hamad Medical Corporation, Doha, Qatar
| | - J J Sico
- VA Connecticut Healthcare System, West Haven, CT, USA.,Yale University School of Medicine, New Haven, CT, USA
| | - V C Marconi
- Emory University School of Medicine and Rollins School of Public Health, Atlanta VA Medical Center, Atlanta, GA, USA
| | - S Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - M C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VAMC, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - M Budoff
- Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles (UCLA), Torrance, CA, USA
| | - C L Gibert
- Washington DC Veterans Affairs Medical Center and George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - C-Ch Chang
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - R Bedimo
- VA North Texas Health Care System, Dallas, TX, USA
| | - M S Freiberg
- VA Tennessee Valley Healthcare System, Vanderbilt University School of Medicine, Nashville, TN, USA
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Butt AA, Yan P, Shaikh OS, Freiberg MS, Re VL, Justice AC, Sherman KE. Virologic response and haematologic toxicity of boceprevir- and telaprevir-containing regimens in actual clinical settings. J Viral Hepat 2015; 22:691-700. [PMID: 25524834 PMCID: PMC5020421 DOI: 10.1111/jvh.12375] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/06/2014] [Indexed: 12/17/2022]
Abstract
Effectiveness, safety and tolerability of boceprevir (BOC) and telaprevir (TPV) in actual clinical settings remain unknown. We determined rates of sustained virologic response (SVR) and haematologic adverse effects among persons treated with BOC- or TPV-containing regimens, compared with pegylated interferon/ribavirin (PEG/RBV). Using an established cohort of hepatitis C virus (HCV)-infected persons, Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), we identified those treated with a BOC- or TPV-containing regimen and HCV genotype 1-infected controls treated with PEG/RBV. We excluded those with HIV coinfection and missing HCV RNA values to determine SVR. Primary endpoints were SVR (undetectable HCV RNA ≥12 weeks after treatment completion) and haematologic toxicity (grade 3/4 anaemia, neutropenia and thrombocytopenia). We evaluated 2288 persons on BOC-, 409 on TPV-containing regimen and 6308 on PEG/RBV. Among these groups, respectively, 31%, 43% and 9% were treatment-experienced; 17%, 37% and 14% had baseline cirrhosis; 63%, 54% and 48% were genotype 1a. SVR rates among noncirrhotics were as follows: treatment naïve: 65% (BOC), 67% (TPV) and 31% (PEG/RBV); treatment experienced: 57% (BOC), 54% (TPV) and 13% (PEG/RBV); (P-value not significant for BOC vs TPV; P < 0.0001 for BOC or TPV vs PEG/RBV). Haematologic toxicities among BOC-, TPV- and PEG/RBV-treated groups were as follows: grade 3/4 anaemia 7%, 11% and 3%; grade 4 thrombocytopenia 2.2%, 5.4% and 1.7%; grade 4 neutropenia 8.2%, 5.6% and 3.4%. SVR rates are higher and closer to those reported in pivotal clinical trials among BOC- and TPV-treated persons compared with PEG/RBV-treated persons. Haematologic adverse events are frequent, but severe toxicity is uncommon.
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Affiliation(s)
- A. A. Butt
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,VA Pittsburgh Healthcare System, Pittsburgh, PA, USA,Hamad Medical Corporation, Doha, Qatar
| | - P. Yan
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - O. S. Shaikh
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - M. S. Freiberg
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - V. Lo Re
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - A. C. Justice
- Veterans Affairs Healthcare System, West Haven, CT, USA,Yale University School of Medicine, New Haven, CT, USA
| | - K. E. Sherman
- University of Cincinnati Medical Center, Cincinnati, OH, USA
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Erqou S, Mohanty A, McGinnis KA, Vanasse G, Freiberg MS, Sherman KE, Butt AA. Hepatitis C virus treatment and survival in patients with hepatitis C and human immunodeficiency virus co-infection and baseline anaemia. J Viral Hepat 2013; 20:463-9. [PMID: 23730839 DOI: 10.1111/jvh.12107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 03/02/2013] [Indexed: 12/24/2022]
Abstract
The impact of pretreatment anaemia on survival in individuals with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection is not known. Moreover, HCV treatment is offered less frequently to individuals with anaemia, due to haematological side effects of the treatment regimen. This study aimed to determine the effect of HCV treatment on survival among HCV/HIV co-infected individuals with pretreatment anaemia using the Electronically Retrieved Cohort of HCV-Infected Veterans (ERCHIVES). Individuals with HCV/HIV co-infection were included in current analyses. Participants were considered treated if they were prescribed ≥ 4 weeks of HCV treatment. All-cause mortality data were obtained using record linkage. Survival analyses were performed using Cox proportional hazard models. Among 5000 HCV/HIV co-infected individuals, 1671 (33.4%) had pretreatment anaemia. In a follow-up period of up to 7 years (19,500 person-years), individuals with anaemia had significantly higher mortality rate compared with those without anaemia [144.2 (95% CI: 134.5-154.7) vs 47.5 (44.0-51.2) per 1000 person-years, respectively]. Among individuals with anaemia, HCV treatment was associated with significantly lower mortality rate [66.6 (44.3-100.2) vs 149.6 (139.2-160.5) per 1000 person-years, for treated vs untreated, respectively]. Treatment remained associated with substantial survival benefit after taking into account the effect of multiple comorbidities (hazards ratio: 0.34, 95% CI: 0.21-0.62). These data suggest that HCV/HIV co-infected individuals with pretreatment anaemia have significantly higher mortality compared with those without anaemia. HCV treatment is associated with substantial survival benefit in this group. Additional studies are needed to determine strategies to improve HCV treatment rates among this group.
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Affiliation(s)
- S Erqou
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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