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TOPLINE:

In a multicohort analysis of patients with HIV, those with mental health disorders had a markedly higher risk for mortality than those without such conditions, leading to a shorter lifespan. The effect was particularly pronounced among patients diagnosed with substance use or psychotic disorders.

METHODOLOGY:

• Researchers determined life-years lost due to mental health disorders among patients with HIV infection, comparing those with and without such conditions who initiated antiretroviral therapy between 2000 and 2021.
• The study included 119,785 patients from South Africa (median age, 39.4 years; 42.6% men) and 142,044 from North America (median age, 43.1 years; 85.0% men), with median follow-up durations of 4.3 and 5.3 years, respectively.
• Mental health disorders including psychotic disorders, bipolar disorders, depression, anxiety, and substance use disorders were identified using diagnostic codes.
• Life-years lost due to mental health diagnoses were calculated as the average difference in remaining life expectancy between patients with and without these disorders.

TAKEAWAY:

• Mental health disorders were more prevalent in North America than in South Africa (65.1% vs 48.4%). In South Africa, prevalence rates were higher among women than among men, whereas the opposite trend was seen in North America.
• Life-years lost associated with any mental health disorder were 3.42 years in men (95% CI, 2.42-4.28) and 2.95 years in women (95% CI, 1.30-4.99) in South Africa and were 4.16 years in men (95% CI, 3.71-4.59) and 4.64 years in women (95% CI, 2.93-6.05) in North America compared with patients without the disorder.
• Psychotic disorders were associated with a loss of 7-9 life-years, whereas substance use disorders were associated with a loss of 4-10 life-years, showing a greater effect than depression or anxiety in both regions.
• In both regions and sexes, most life-years lost attributable to any mental health disorder were due to natural causes of death and occurred at CD4 counts ≥ 350 cells/μL in South Africa but at CD4 counts < 350 cells/μL in North America.

IN PRACTICE:

“While patients should always be assessed individually without implicit bias regarding their medication adherence, there should be a greater emphasis on enhancing HIV care for patient groups with considerable losses at low CD4 cell counts, such as those with severe mental disorders or substance use issues, to reduce HIV-related mortality,” the authors of the study wrote.

SOURCE:

This study was led by Yann Ruffieux, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. It was published online on August 18, 2025, in the Journal of the International AIDS Society.

LIMITATIONS:

Mental health was assessed using diagnostic codes from routine medical records, which failed to capture undiagnosed cases and milder conditions. The analysis did not account for remission of mental illness and relied on the accuracy of data on cause of death. Additionally, the life-years lost metric is descriptive and does not establish causality.

DISCLOSURES:

This study was funded by multiple US National Institutes of Health organizations including the National Institute of Allergy and Infectious Diseases, the National Cancer Institute, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development as well as various other sources in South Africa. In North America, it was supported by the National Institutes of Health, the CDC, the Agency for Healthcare Research and Quality, and other organizations. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.