Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Mental health disorders and the risk of AIDS-defining illness and death in HIV-infected veterans Diana Nurutdinova a,b , Timothy Chrusciel a,b , Angelique Zeringue a,b , Jeffrey F. Scherrer a,b , Ziyad Al-Aly a , Jay R. McDonald a,b and Edgar T. Overton b Objective: Mental health comorbidities are common in HIV-infected veterans and can impact clinical outcomes for HIV. We examined the impact of mental health diagnoses on progression to AIDS-defining illness (ADI) and death in a large cohort of HIV-infected veterans who accessed care between 2001 and 2006. Design: Retrospective cohort study using the national Veterans Health Administration (VHA) HIV Clinical Case Registry. Methods: We identified HIV-infected veterans initiating combination antiretroviral therapy (cART) within the VHA between 2000 and 2006. The prevalences of the following mental health diagnoses were examined: schizophrenia, bipolar disorder, depression, anxiety, and substance use disorder. Cox proportional hazards models were constructed to examine the relationship between mental health conditions and two outcomes, all-cause mortality and ADI. Models were computed before and after adjusting for confounding factors including age, race, baseline CD4 cell count, comorbidities and cART adherence. Results: Among 9003 veterans receiving cART, 31% had no mental health diagnosis. Age, race, baseline comorbidity score, CD4, and cART adherence were associated with shorter time to ADI or death. All-cause mortality was more likely among veterans with schizophrenia, bipolar disorder and substance use, and ADI was more likely to occur among veterans with substance use disorder. Conclusions: Our results demonstrate the high prevalence of mental health diagnoses among HIV-infected veterans. In the era of highly active antiretroviral therapy, presence of psychiatric diagnoses impacted survival and development of ADI. More aggressive measures addressing substance abuse and severe mental illness in HIV-infected veterans are necessary. ß 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2012, 26:229–234 Keywords: HIV, mental health, mortality, outcomes, veterans Introduction The Veterans’ Affairs medical system is the largest inte- grated provider of HIV care in the US. Up to 63% of HIV- infected veterans have at least one mental health diagnosis [1–3]. The co-occurrence of mental illness and HIV results in worse outcomes and higher healthcare costs [4]. The impact of depression among HIV-infected persons is well documented, affecting medication adherence [5], CD4 cell count [6], innate immune function [7], and mortality [8–11]. However, data regarding other psychiatric diagnoses are limited due to the low prevalence of some mental health disorders, under- recognition by HIV providers [12] and limited access to mental healthcare [13,14]. With combination antiretro- viral therapy (cART) long-term HIVoutcomes continue to improve [15]. However, treatment outcomes in the setting of co-occurring mental illness are not well described. a St. Louis VA Medical Center, and b Washington University School of Medicine, St. Louis, Missouri, USA. Correspondence to Diana Nurutdinova, 915 North Grand Blvd, St. Louis, MO 63130, USA. Tel: +1 314 652 4100 x54419; fax: +1 314 289 7007; e-mail: diana.nurutdinova@va.gov Received: 23 June 2011; revised: 19 September 2011; accepted: 12 October 2011. DOI:10.1097/QAD.0b013e32834e1404 ISSN 0269-9370 Q 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 229