One in five women living with HIV depressed, engages in heavy drinking, smoking

Co-occurring and long-term heavy drinking, smoking, and depressive symptoms are common among women living with HIV, according to a study presented at the 24th International AIDS Conference (AIDS 2022). In turn, such sustained syndemics appear to worsen mortality in this population.

In characterizing the long-term patterns of alcohol use, tobacco smoking, and depressive symptoms, the researchers drew 1994–2017 data from the prospective and observational Woman’s Interagency HIV Study. The present sample included 3,282 patients, from whom syndemic phenotypes were generated according to the co-occurrence of the above high-risk traits.

The main outcome measure was death, as determined from a review of the National Death Index. Causes of death were also assessed.

Syndemics analysis revealed that 17 percent of the participants showed two or more of the high-risk traits. Of this subgroup, majority (67 percent) were smoking and had depression, while 20 percent engaged in heavy drinking and smoking. Only two percent were heavy drinkers and had depression. Meanwhile, the remaining 12 percent demonstrated all three traits. [AIDS 2022, abstract EPB082]

Majority of the patients demonstrated none of these high-risk phenotypes (45 percent). In comparison, 28 percent, 9 percent, and 1 percent were current smokers only, had depressive symptoms only, and were heavy drinkers only, respectively.

Over a median follow-up of 18.5 years, 616 participants died. Cox proportional hazards analysis revealed that sustained syndemics significantly worsened mortality in women living with HIV.

Compared to those who showed no high-risk traits, women with ≥2 such phenotypes were around four times more likely to die from all causes (hazard ratio [HR], 3.93, 95 percent confidence interval [CI], 3.07–5.04), from non-AIDS causes (HR, 3.83, 95 percent CI, 3.08–4.78), and from non-AIDS or overdose causes (HR, 4.28, 95 percent CI, 3.06–5.99).

According to the researchers, these “[f]indings underscore the need for coordinated strategies to screen and treat these co-occurring conditions.”

Screening works

Another study at AIDS 2022 lent more weight to such a recommendation.

Using an augmented microsimulation model, researchers from the New York University Grossman School of Medicine and the Yale School of Medicine found that primary care screening for the constellation of alcohol, substance, and mood disorders (CASM) could improve survival outcomes among people living with HIV (PLHIV). [AIDS 2022, abstract EPB071]

The team drew from a large PLHIV cohort of veterans, looking at the co-occurrence of individual CASMs and how treating each condition could potentially impact HIV treatment adherence, preventive care, and outcomes.

Their analysis showed that the saturation strategy—diagnostic assessment for all CASM conditions—could increase PLHIV life expectancy by 0.95 years as compared with no screening.

Similarly, an integrated care strategy that assessed for alcohol, tobacco, and/or depression, along with diagnostic assessments for other conditions, improved life expectancy by 0.82 years. Such an approach could match the benefits of saturation strategy while imposing a lower diagnostic burden on healthcare systems.