Efavirenz Is Not Associated with an Increased Risk of Depressive Disorders in Patients Living with HIV: An 11-Year Population-Based Study in Taiwan.

Chia-Wen Li,Yen-Chin Chen,Wen-Chien Ko,Po-Lin Chen,Nai-Ying Ko,Ming-Chi Li,Nan-Yao Lee,Chung-Yi Li

doi:10.3390/healthcare9121625

Abstract

(1) Background: This study aimed to determine the association between the use of efavirenz and depressive disorders among human immunodeficiency virus (HIV)-infected patients. (2) Methods: A retrospective cohort study was conducted using Taiwan’s National Health Insurance Database. We identified patients receiving anti-retroviral therapy (ART) between 2000 and 2009; these patients were followed until 2010 for diagnoses of depressive disorders using the Cox proportional hazard model to estimate hazard ratios. (3) Results: After up to 11 years of follow-up, the incidence of depressive disorders for the efavirenz-treated group was estimated at 12.2/1000 person-years (PYs), and the control group was at 12.5/1000 PY (p = 0.822). The independent risk factors for depressive disorders included an insurance premium of less than NTD 17,820 (New Taiwan Dollars—NTD) (adjusted hazard ratio (aHR) 2.59, 95% confidence interval (CI), 1.79–3.76, p < 0.001), and between NTD 17,821 and NTD 26,400 (aHR 1.55, 95% CI, 1.04–2.31, p = 0.030), living in Southern Taiwan (aHR 1.49, 95% CI, 1.21–1.84, p = 0.002), and with a psychiatric history (excluding depressive disorders) (aHR 4.59, 95% CI, 3.51–6.01, p = 0.030). (4) Conclusions: This study concluded that ART-treated patients with a past history of psychiatric disorders, lower insurance premium, and living in Southern Taiwan have an increased risk of depressive disorders, which are not associated with the use of efavirenz.

Highlights

Human immunodeficiency virus (HIV)-infected individuals have been found to experience a higher prevalence of psychiatric disorders, with rates exceeding those of the general population [1,2]
We found that human immunodeficiency virus (HIV)-infected patients with a past history of psychiatric disorders other than depressive disorders were more likely to develop depressive disorders during the follow-up
In an attempt to assess the potential for confounding by indication, we used age at HIV diagnosis, gender, and past history of psychiatric disorders to calculate the propensity score for the physicians’ treatment assignment, but there were no obvious differences in the distribution of the propensity score between the two comparison groups. This population-based study found that efavirenz use was not significantly associated with an increased risk of depressive disorders among HIV-infected patients

Summary

Introduction

Human immunodeficiency virus (HIV)-infected individuals have been found to experience a higher prevalence of psychiatric disorders, with rates exceeding those of the general population [1,2]. A nationwide population-based study conducted in Taiwan noted that the three leading psychiatric disorders in HIV-infected individuals included anxiety disorders, depressive disorders, and alcohol/substance use [3]. Depression is one of the major challenges facing people living with HIV [4]. Previous studies have shown varying prevalence of depression in HIV-infected individuals in different parts of the world, ranging from 12% to 60% [5,6,7,8,9]. Socioeconomic disadvantage has been noted to increase the risk of depression among subgroups of the HIV-infected population in a Brazilian study [10]

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