HIV Independently Associated With Mortality in Schizophrenia

People living with HIV have a higher incidence of schizophrenia and an associated increase in mortality compared with people who do not have HIV, according to a study published in Schizophrenia Research.

In this population-based cohort study, researchers compared available data on health outcomes and utilization of health services for people living with HIV and the general population in British Columbia. The study population included individuals with concurrent HIV and schizophrenia diagnoses (HIV+/SZO+, n=835), individuals with HIV but without a schizophrenia (SZO) diagnosis (HIV+/SZO-, n=12,499), individuals with a schizophrenia diagnosis but without HIV (HIV-/SZO+, n=5619), and individuals with neither HIV nor schizophrenia (HIV-/SZO-, n=495,171).

Researchers identified and adjusted for relevant variables, including history of injected drug use, substance abuse disorder with and without the inclusion of alcohol, use of psychiatric services in hospital, and use of antipsychotic medication.

People living with HIV were more likely to have a schizophrenia diagnosis than those without HIV (6.3%; 95% CI, 5.9-6.7; P <.001, vs 1.1%; 95% CI, 1.1-1.2). Compared with HIV-/SZO+, HIV+/SZO+ were more likely to have a concurrent substance abuse disorder (89.3% vs 42.6%; P <.05), to have ever used anti-psychotic medication (48.3% vs 38.8%; P <.05) and to have ever accessed psychiatric services (69.7% vs 59.8%; P <.05).

During the study period, the mortality rate among HIV+/SZO+ increased compared with HIV-/SZO+ (25.5% vs 17.8%; P <.001). Age- and sex-adjusted all-cause mortality rates were highest among HIV+/SZO+ at 64.5 per 1,000 person-years (PY) (95% CI, 48.5-80.5), followed by HIV+/SZO- at 39.7 per 1,000 PY (95% CI, 36.9-42.6), HIV-/SZO+ at 28.2 per 1,000 PY (95% CI, 26.5-29.9), and HIV-/SZO- at 9.9 per 1,000 PY (95% CI, 9.8-10.0).

Unadjusted and adjusted analyses revealed that having a schizophrenia diagnosis was not associated with all-cause mortality in people living with HIV (adjusted odds ratio [aOR]=0.90; 95% CI, 0.74-1.09). Among individuals with a schizophrenia diagnosis, being HIV positive (OR=1.59; 95% CI, 1.34-1.88) was associated with the increasing odds of mortality in unadjusted analyses.

Limitations of this study include the differential probability of receiving clinical diagnoses among people living with HIV and individuals without HIV, and the possibility that individuals with schizophrenia have increased HIV prevalence because they have a higher incidence of substance abuse disorder and sexually risky behaviors.

Individuals diagnosed with schizophrenia are more likely than the general population to have a blood-borne comorbidity, including HIV. More research is needed to better understand the rates and drivers of HIV among individuals diagnosed with schizophrenia and the role of HIV prevention in schizophrenia care. The researchers also suggested that “efforts should be made to identify and link to care individuals disproportionately affected by schizophrenia and excess mortality, including those living with HIV.”

Several researchers acknowledge conflicts of interest. Please see reference for the full list of disclosures.

Reference
Closson K, McLinden T, Patterson TL, et al. HIV, schizophrenia, and all-cause mortality: A population-based cohort study of individuals accessing universal medical care from 1998 to 2012 in British Columbia, Canada [published online June 26, 2019]. Schizophr Res. doi: 10.1016/j.schres.2019.04.020