Death rate triples among people living with HIV who have a mental illness
South African study finds people living with both HIV and mental illness are far more likely to die than their peers, regardless of HIV care.
Researchers are warning of an “urgent public health problem” after an analysis of people living with HIV in Cape Town found those with a mental illness are almost three times more likely to die early than their peers, regardless of the quality of HIV care they receive.
The study also found that people with a mental illness are marginally more likely to drop out of antiretroviral treatment (ART) and experience treatment failure than other people on ART. But this difference did not account for the higher rate of premature deaths experienced by people living with HIV who have a mental illness.
The study analysed data relating to around 58,660 people receiving ART in Cape Town between 2004 and 2017. Around 70% were women.
In total, 5% of people had a mental illness, defined as receiving psychiatric medication or being hospitalised due to a mental health issue in the past five years.
Researchers analysed each patient’s records from the time they started ART or from 2010 (whichever occurred later) until 2017 or until treatment ended due to death or for another reason. This equated to an analysis period of around four years for each person. Around 7% died during this time, of whom 78% died from a natural cause, 5% from an unnatural cause, and 16% from an unknown cause.
People with a mental illness were almost three times more likely to die from natural causes and two times more likely to die from unnatural causes than people on ART who did not have a mental illness. This remained the case even after taking into consideration whether someone stayed in HIV care or not and whether they were virally suppressed, as well as other factors such as their age, sex and the year they began ART.
In fact, the largest difference in death rate between people living with HIV with and without a mental illness was found among people who remained on ART and were virally suppressed. This suggests other factors are responsible for the higher number of deaths among people living with HIV who have a mental illness. For instance, people with a mental illness are more likely to also have a physical illness, are more likely to engage in damaging behaviours, such as eating a poor diet and drinking alcohol, and are more likely to have inadequate healthcare.
The study’s findings suggest HIV programmes need to look beyond simple measures that support people to stay on ART and instead address people’s complex physical and mental health needs.
The study’s authors said: “Although evidence for the effectiveness of strategies to improve survival in people with mental illness is scarce, we believe that interventions addressing the multiple underlying drivers of excess mortality [deaths] hold promise for closing the mortality gap between people with and without mental illness.”