Depression and human immunodeficiency virus infection are risk factors for incident heart failure among veterans veterans aging cohort study

Jessica R. White, Chung Chou H. Chang, Kaku A. So-Armah, Jesse C. Stewart, Samir K. Gupta, Adeel A. Butt, Cynthia L. Gibert, David Rimland, Maria C. Rodriguez-Barradas, David A. Leaf, Roger J. Bedimo, John S. Gottdiener, Willem J. Kop, Stephen S. Gottlieb, Matthew J. Budoff, Tasneem Khambaty, Hilary A. Tindle, Amy C. Justice, Matthew S. Freiberg

Research output: Contribution to journalArticle

24 Scopus citations


Background-Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF. Methods and Results-Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (n=81 427: 26 908 HIV+, 54 519 without HIV [HIV-]) were categorized into 4 groups: HIV-without major depressive disorder (MDD) [reference], HIV-with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% confidence interval [CI], 8.20-10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95% CI, 1.45-1.95) compared with HIV-participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV-and HIV+ participants (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.37; and adjusted hazard ratio, 1.29; 95% CI, 1.11-1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95% CI, 0.58-0.99). Conclusions-Our study is the first to suggest that MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.

Original languageEnglish (US)
Pages (from-to)1630-1638
Number of pages9
Issue number17
StatePublished - Oct 27 2015



  • Depression
  • Epidemiology
  • HIV
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

White, J. R., Chang, C. C. H., So-Armah, K. A., Stewart, J. C., Gupta, S. K., Butt, A. A., Gibert, C. L., Rimland, D., Rodriguez-Barradas, M. C., Leaf, D. A., Bedimo, R. J., Gottdiener, J. S., Kop, W. J., Gottlieb, S. S., Budoff, M. J., Khambaty, T., Tindle, H. A., Justice, A. C., & Freiberg, M. S. (2015). Depression and human immunodeficiency virus infection are risk factors for incident heart failure among veterans veterans aging cohort study. Circulation, 132(17), 1630-1638.