Associations between HIV and schizophrenia in people with
and without substance use disorders and the effect on timeliness of HIV
diagnosis, antiretroviral therapy (ART), and treatment outcomes are poorly
understood. We aimed to assess the association between HIV and schizophrenia
and the effect on HIV treatment outcomes in people with and without substance
use disorders.
We did a population-based cohort study with data from
nationwide registries in Denmark to investigate the risk of schizophrenia after
a diagnosis of HIV and the risk of HIV after a diagnosis of schizophrenia,
accounting for substance misuse, timeliness of HIV diagnosis, and treatment
success in relation to schizophrenia. We selected the cohort from people born
in Denmark between Jan 1, 1955, and Dec 31, 1995, who we followed up from their
16th birthday or Jan 1, 1995 (whichever occurred last) until their death,
emigration from Denmark, onset of schizophrenia, or Dec 31, 2011 (whichever
came first). We estimated incidence rate ratios (IRRs) with Poisson and Cox
regression, with adjustment for calendar period, and age and its interaction
with sex.
We identified 2 786 286 individuals, of whom we included
2 646 154 people in analyses of risk of schizophrenia diagnosis and 2 658 662
people in analyses of risk of HIV diagnosis. In 35 353 633 person-years of
follow up, HIV was associated with an increased risk of schizophrenia and acute psychosis; the IRR was
highest within the first year of HIV diagnosis for both disorders. Schizophrenia was not associated
with an increased risk of HIV in individuals without substance misuse disorders. The risk of schizophrenia in individuals with HIV
decreased after ART. The risk of acute psychosis did not
differ between HIV-infected individuals receiving antiretroviral regimens with
and without efavirenz. We recorded no differences
in CD4 cell counts, time to ART, or viral suppression between individuals with
schizophrenia with HIV and those without schizophrenia when substance use was
taken into account. Between 1999 and 2011, the mortality rate ratio comparing
HIV-infected individuals with schizophrenia with HIV-negative individuals
without schizophrenia was 25·8.
Our findings emphasise the need for interventions to prevent
HIV in people with schizophrenia, especially for those with substance use
disorders, and for accessible mental health services for individuals with HIV and excess mortality.
Via: http://goo.gl/wnoLkh Purchase
full article at: http://goo.gl/k5xy44
By:
- 1Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
- 2National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.
- 3National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.
- 4Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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