Objective(s): To define the incidence of mental health disorders(MHD)\r\nand risk factors associatedwith incident MHDin anHIV clinic settingwith\r\nunrestricted accessto care and limited confounding due to concomitant\r\ninjection drug use (IDU).\r\nDesign: Retrospective cohortstudy.\r\nMethods: Eligible subjectswereHIV infected adultsfollowed at aUS\r\nmilitary treatmentfacility during the calendar year 2005. Incidence\r\nrates are calculatedper 100person years(py).Coxproportional hazards\r\nregressionwere utilized to identify risk factors associatedwith MHD.All\r\npersons not experiencing MHDwere followed untilstudy completion in\r\nJanuary 2008.\r\nResults: 494 subjects(51%Black, 93% male, medianCD4 count 458)\r\nwere followed for 5200py. 160 subjects developed MHDfor an overall\r\nincidence of 3.1/100py offollowup.The incidence of depression and\r\nanxietywere 2.4/100py and 0.4/100py,respectively. Factors associated\r\nwith a diagnosis ofincident MHDinclude receipt of aprotease inhibitor\r\n(PI)based regimen (HR 2.0,referent- noART), non-Black ethnicity, and\r\nHIV diagnosisin thepostHAART era; male genderwasprotective.\r\nConclusion: In a cohortwith limited confounding, incident MHDwas\r\ncommon.Unlikepriorstudies, non-nucleoside reverse transcriptase\r\ninhibitor(NNRTI) use and MHDassociationwas not observed; instead PI\r\nusewas associatedwith MHD,perhaps due to PI enhanced mitochondrial\r\ntoxicity,signaling need forfurtherresearch.Given the significantburden\r\nof MHDobserved in this cohort, mental health screening shouldbe\r\nconsidered in the management ofHIV infection.
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