HIV-positive adults with major depressive disorder had a significantly higher risk of incident heart failure compared with HIV-negative adults without depression (adjusted HR 1.68; 95% CI 1.45-1.95).
Cohort (n=81,427)
Do HIV infection and major depressive disorder increase the risk of incident heart failure in veterans free from cardiovascular disease?
Major depressive disorder is an independent risk factor for incident heart failure in adults with HIV, highlighting the importance of identifying and managing MDD in this population.
Effect estimate: adjusted HR 1.68 (95% CI 1.45-1.95)
BACKGROUND: Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF. METHODS AND RESULTS: Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (n=81 427: 26 908 HIV+, 54 519 without HIV HIV-) were categorized into 4 groups: HIV- without major depressive disorder (MDD) reference, HIV- with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% confidence interval CI, 8.20-10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95% CI, 1.45-1.95) compared with HIV- participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV- and HIV+ participants (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.37; and adjusted hazard ratio, 1.29; 95% CI, 1.11-1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95% CI, 0.58-0.99). CONCLUSIONS: Our study is the first to suggest that MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.
White et al. (Fri,) conducted a cohort in HIV and major depressive disorder (n=81,427). HIV+ with MDD vs. HIV- without MDD was evaluated on Incident heart failure (adjusted HR 1.68, 95% CI 1.45-1.95). HIV-positive adults with major depressive disorder had a significantly higher risk of incident heart failure compared with HIV-negative adults without depression (adjusted HR 1.68; 95% CI 1.45-1.95).