Mortality under plausible interventions on antiretroviral treatment and depression in HIV-infected women: an application of the parametric g-formula

Ann Epidemiol. 2017 Dec;27(12):783-789.e2. doi: 10.1016/j.annepidem.2017.08.021. Epub 2017 Sep 5.


Purpose: Among HIV-infected persons, antiretroviral therapy (ART) and depression are strongly associated with mortality. We estimated reductions in 5-year mortality in Women's Interagency HIV Study participants under plausible hypothetical increases in ART initiation and reductions in depression (CES-D score≥16).

Methods: We followed 885 ART-naïve Women's Interagency HIV Study participants for 5 years from their first study visit after April 1998 to death or censoring. We used the parametric extended g-formula to estimate cumulative mortality under the natural course (NC) and alternative exposure distributions.

Results: Baseline prevalence of depression was 52% and 62% initiated ART by 5 years. Compared with mortality under NC (13.2%), immediate ART and elimination of 36% or 67% of depressive episodes were associated with risk differences (RDs) of -5.2% (95% CI: -7.7%, -2.6%) and -5.7 (95% CI: -8.7, -2.7). Compared with immediate ART and NC for depression, additionally eliminating 67% of the depressive episodes was associated with RD = -1.6 (95% CI: -3.9, 0.8). Compared with 5-year mortality under NC for ART and elimination of 67% of depression, also initiating ART immediately was associated with RD = -2.6 (95% CI: -5.0, -0.3).

Conclusions: Increasing ART initiation and reducing depression were associated with moderate reductions in 5-year mortality among HIV-infected women.

Keywords: Antiretroviral therapy; Cohort studies; Depression; HIV; Mortality; Survival analysis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / adverse effects
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active*
  • Depression / epidemiology*
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / mortality*
  • Humans
  • Middle Aged
  • Prevalence
  • Risk Factors
  • Survival Analysis
  • United States


  • Anti-HIV Agents