Abstract Body

Mental health (MH) conditions are a significant source of morbidity and mortality globally, with a higher burden in people with HIV (PWH). However, treat-all era differences in HIV outcomes for those with and without MH conditions are understudied, and essential for informing the ‘Ending the HIV Epidemic’ (EHE) initiative. We describe the prevalence of depression, anxiety, bipolar disorder (BD) and schizophrenia in PWH and the differences in HIV care continuum outcomes in those with and without MH conditions.

Using data from adults (?18 years) with HIV in the NA-ACCORD, we estimated annual prevalence of anxiety disorders, depressive disorders, BD and schizophrenia from 2008-2018 based on ICD code mapping. MH multimorbidity was defined as having 2 or more mental health diagnoses. Log binomial models with generalized estimating equations estimated crude (PR) and adjusted prevalence ratios (aPR) and 95% confidence intervals ([,]) for retention in care (?2 HIV primary care visits >90 days apart in a calendar year) and HIV viral suppression (HIV RNA <200 copies/mL at last measurement of the year) by presence vs. absence of each MH condition in the most recent calendar years (2016-2018). Covariates in adjusted models included age, race/ethnicity, HIV acquisition risk and cohort.

Among 122,896 PWH in HIV care from 2008-2018, 67,643 (55.1%) were diagnosed with 1 or more of four assessed MH diagnoses: 39% with depressive disorders, 28% with anxiety disorders, 10% with BD, and 5% with schizophrenia. The prevalence of depressive and anxiety disorders increased between 2008-2018, while BD and schizophrenia prevalence were stable. MH multimorbidity (vs. no MH diagnoses) was common affecting 24% of PWH. Regardless of MH diagnoses, retention in care decreased over time, however viral suppression increased (Figure 1). From 2016-2018 (N=64,684), retention in care and HIV viral suppression prevalence did not differ by single MH diagnosis, however those with MH multimorbidity (16%) had a greater prevalence of retention in care (PR=1.04 [1.04, 1.05]) but lower prevalence of viral suppression (PR=0.98 [0.97, 0.99]) compared to those without MH diagnoses.

The prevalence of MH and MH multimorbidity among PWH was high. Although retention was similar to people without MH diagnoses, viral suppression was lower in those with MH multimorbidity. To achieve EHE goals of viral suppression, tailored interventions for PWH with MH multimorbidity may be needed.