A 20-year population-based study of all-cause and cause-specific mortality among people with concurrent HIV and psychotic disorders

Abstract

Objective:We aimed to characterize mortality among people with HIV (PWH) and psychotic disorders (PWH/psychosis+) vs. PWH alone (PWH/psychosis−).Method:A population-based analysis of mortality in PWH (age ≥19) in British Columbia (BC) from April 1996 to March 2017 was conducted using data from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) study. Deaths were identified from the Vital Statistics Data (classified as HIV vs. non-HIV causes). Mortality trends across all fiscal years were examined. Cox models assessed the hazard of psychotic disorders on mortality; possible differences between schizophrenia and nonschizophrenia types of psychotic disorders were also evaluated.Results:Among 13 410 PWH included in the analysis, 1572 (11.7%) met the case definition for at least one psychotic disorder. Over the study period, 3274 deaths (PWH/psychosis−: n = 2785, PWH/psychosis+: n = 489) occurred. A decline over time in all-cause mortality and HIV-related mortality was observed in both PWH/psychosis+ and PWH/psychosis− (P value <0.0001). A decline in non-HIV mortality was observed among PWH/psychosis− (P value = 0.003), but not PWH/psychosis+ (P value = 0.3). Nonschizophrenia psychotic disorders were associated with increased risk of mortality; adjusted hazard ratios with (95% confidence intervals): all-cause 1.75 (1.46–2.09), HIV-related 2.08 (1.60–2.69), non-HIV-related 1.45 (1.11–1.90). Similar associations between schizophrenia and mortality were not observed.Conclusion:People with co-occurring HIV and nonschizophrenia psychotic disorders experienced a significantly higher risk of mortality vs. PWH without any psychotic disorder. Implementing care according to syndemic models considering interactions between HIV and particularly episodic psychotic disorders could help manage mortality risk more effectively among PWH/psychosis+.

Characterizing opioid agonist therapy uptake and factors associated with treatment retention among people with HIV in British Columbia, Canada

“…Psychotic disorders (yes, no), diabetes mellitus (yes, no), and HIV viral load suppression (yes, no, unknown) were measured as categorical time-varying variables at the beginning of each new OAT episode. Psychotic disorders were determined based on one applicable hospitalization (DAD) or two healthcare encounters (MSP) within a twelve-month period using specific diagnostic codes, as previously described ( Yazdani et al, 2022 , Chronic Disease Information Working Group, 2018 ). Diabetes mellitus was identified based on various criteria, including hospitalizations (DAD), healthcare encounters (MSP), insulin, and oral antihyperglycemic prescriptions (PharmaNet), all within a twelve-month period ( Chronic Disease Information Working Group, 2018 ).…”

“…In BC, the illicit drug toxicity has reduced survival gains achieved by combination antiretroviral therapy (ART) among PWH ( St-Jean et al, 2021 ). Recent evidence indicates a shift in mortality patterns among PWH, with non-HIV causes, particularly accidental overdoses, becoming the leading cause of death from 2010 onwards ( Yazdani et al, 2022 , Salters et al, 2021 ).…”