HIV-positive gay and bisexual men have increased risk of hospitalisation with anxiety and mood disorders, a risk factor for later mortality

HIV-positive gay 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 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 [gay and bisexual men] cohorts.”

More attention 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 people living with HIV. 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.

Investigators in 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.

Participants came 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 between 1998 and 2006, whereas recruitment to the HIV-negative cohort took place between 2001 and 2004. Both cohorts consisted exclusively of men who identified as gay or bisexual. 

Information on hospital admissions with AMDs and deaths was obtained from hospital records, HIV administrative records and death registries. Follow-up was to the end of 2012.

At baseline, 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 pre-cART era.

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).

Hospitalisation rates with a primary AMD diagnosis were 9.7 times higher among HIV-positive men compared with rates in the adult male Australian population.

Factors associated 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).

Interestingly, individuals 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 cell count.

Mortality analysis showed that 19 people hospitalised with AMDs died, four of whom were HIV-positive.

After adjustment for other risk factors, hospitalisation with AMDs was associated with a more than fivefold 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 or secondary cause of death in 42% of HIV-positive people hospitalised for AMDs.

“This research 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.”