The Association between Polypharmacy and Depression among Middle-aged and Aging Men Living with HIV or without HIV

Introduction Polypharmacy, defined as the regular use of 5 or more medications at the same time, is common in older adults. It has been linked to negative mental health outcomes such as dementia, depression, and death. While polypharmacy and depression are prevalent among sexual minority men living with or without HIV, it is unclear if HIV status moderates the association between polypharmacy and depression. This study aims to investigate whether polypharmacy increases the odds of depressive symptoms in people living with vs without HIV among middle-aged and aging participants of the Multicenter AIDS Cohort Study (MACS). Methods This study used cross-sectional data from 2236 sexual minority men in a sub-study titled “Understanding Healthy Aging Among Men Who Have Sex With Men” conducted in MACS participants. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). In accordance with the Centers for Disease Control and Prevention, polypharmacy was defined as the use of 5 or more non-HIV medications taken since their last visit. Multivariable logistic regression models were used to estimate the association between polypharmacy and depression of (1) the entire sample of men and (2) among only the men living with HIV, adjusting for race and ethnicity, education, insurance status, and the number of health care visits. Results Although not statistically significant, polypharmacy use was associated with having depressive symptoms (OR, 1.15; 95% CI, 0.89-1.49, P=.27) among men living with or without HIV. Additionally, among people living with HIV and the overall sample, non-Hispanic Black participants had increased odds of having depressive symptoms (PLWH: OR, 1.04; 95% CI, 0.70-1.54, P=.86; overall: OR, 1.15; 95% CI, 0.85-1.55, P=.35). Having had some or full graduate school was statistically significantly associated with decreased odds of having depressive symptoms in people living with HIV and the overall sample (OR, 0.50; 95% CI, 0.29-0.86, P=.01; overall: OR, 0.46; 95% CI, 0.31-0.66, P<.001). Conclusions Our findings underscore the need for integrated care that combines mental health screening with medication review, particularly for aging men with HIV or without HIV who are managing multiple chronic conditions.