High Risk of Hospitalization for Mood Disorders in HIV-Positive Gay and Bisexual Men

Gay and bisexual men (GBM) with HIV have an increased risk of hospitalization due to anxiety and mood disorders (AMDs), according to a recent study.

It is well known that there is a high prevalence of mental health issues in the HIV-positive population, reported NAM. Although prior research has investigated the prevalence of AMDs, the findings have yielded varying results.

In a study published in the Journal of Acquired Immune Deficiency Syndromes, researchers sought to examine the relationship between HIV-status and hospitalization for AMDs in GBM. To address the limitations in previous studies, researchers designed a study that focused on gay and bisexual men, who are known to have a higher risk of mental health issues compared with the general population, along with the relationship between HIV status and hospitalization due to AMDs.

The researchers also assessed whether admission to the hospital with this type of mental health issue was predictive of death, and whether the risk differed between men who were HIV-positive and HIV-negative. Researchers used 2 cohorts for the study with one consisting of 557 HIV-positive men (n=557) and the other of 1882 HIV-negative men (n=1882).

Both cohorts consisted exclusively of men who identified as gay or bisexual. At baseline, the median age of the HIV-positive cohort was 41-years-old, while the HIV-negative cohort was 35-years-old.

Two-thirds of the men with HIV had a college education. Illicit drug use was common, with more than 80% of men in both cohorts reporting use within the previous 6 months.

The prevalence of psychological distress was staggeringly higher in HIV-positive men (60%) compared with HIV-negative men (1%). There were 74% of men who had HIV reporting the use of combination antiretroviral therapy (cART), 45% who had a recent CD4 count above 500 cells/mm³, and 77% who were diagnosed in the pre-cART era.

The results of the study found there were 300 hospitalizations for AMDs in 15.3% of HIV-positive participants, and 181 in 5.4% of HIV-negative participants. HIV-positive men with a primary AMD diagnosis had hospitalization rates that were 9.7 times higher, compared with the adult male Australian population.

Some factors associated with hospitalization included having HIV, identifying as bisexual rather than gay, being religious, having previously sought support for mental health problems, and being a smoker. Patients who drank small amounts of alcohol were less likely to have an admission compared with non-drinkers.

Some additional risk factors in the HIV cohort included previous hospitalization for HIV-related dementia, a more recent HIV diagnosis, and a CD4T cell count above 350/ mm³.

In the mortality analysis, researchers found that 19 of the patients who were hospitalized with AMDs died, 4 of which were HIV-positive.

Once the results were adjusted for other risk factors, hospitalization with AMDs was associated with a more than 5-fold increase in mortality risk, and the mortality risk did not differ by HIV status, according to the study. Alcohol abuse or liver failure was listed as a primary or secondary cause of death in 42% of patients with HIV who were hospitalized for AMDs.

“This research highlights the importance of providing more effective strategies to identify and treat AMDs in HIV-infected GBM,” the study authors wrote. “Our research suggests the importance of further examination and joint effects of substance use, neurocognitive decline, and AMDs on health outcomes in HIV-infected individuals.”