Abstract Body

Mental illness can adversely affect HIV treatment outcomes and survival. We estimated excess life-years lost (ELYL) associated with mental illness among people living with HIV in South Africa.

We conducted a cohort study using routine data from the private Aid for AIDS (AfA) disease management program covering the years 2012 to 2018. The cohort was supplemented with mortality records from the South African National Population Register. We followed up patients aged 15 years or older, starting from their date of enrolment into the program until their transfer out, their death, or database closure. We used hospital discharge summaries (ICD-10 diagnoses F00-F99) as indicator of mental illness. We calculated ELYL associated with mental illness by estimating how many more years of life someone with a mental illness was expected to lose before the age of 75 compared to someone without the illness. We divided ELYL into natural and unnatural death components. Additionally, we computed ELYL associated with the following subtypes of mental illnesses: organic disorder (ICD-10 F00-F09), non-organic disorder (F10-F99), psychotic disorder (F20-F29), bipolar disorder (F31), depression (F32, F33, F34.1, F54), and anxiety (F40-F49).

Of the 122,853 AfA participants eligible for this study, 8,505 were hospitalized for a mental illness, including 7,102 for depression, 1,133 for anxiety disorder, 1,030 for a substance use disorder, 857 for a bipolar disorder, 545 for an organic disorder and 291 for a psychotic disorder. The mortality rate was 1.9/100 person-years (py) (95% CI 1.7-2.1) in patients with a mental illness and 0.8/100 py (95% CI 0.8-0.9) in patients without. The number of ELYL associated with any mental illness was 7.8 (95% CI 6.7-8.9, Figure), divided into 7.5 (95% CI 6.2-8.5) from natural deaths and 0.4 (95% CI 0.0-0.9) from unnatural deaths. The ELYL were higher in men (9.2, 95% CI 7.9-10.4) than in women (6.6, 95% CI 5.0-8.3). The ELYL associated with organic disorders (16.6, 95% CI 15.3-17.7) were three times that associated with non-organic disorders (5.7, 95% CI 4.1-6.9).

Data on life-years lost associated with mental illness in people living with HIV are lacking. We found that, on average, AfA particpants hospitalized for a mental illness lost eight more years of life before the age of 75 compared to the rest of the cohort. Further studies are required that explore the causal pathways between mental illness and mortality in people living with HIV.