Serious mental illness (SMI) is associated with earlier mortality. The objective of this study was to determine if SMI was associated with an increased risk of death among Maryland Medicaid beneficiaries with human immunodeficiency virus (HIV). This was a retrospective cohort study of adult Maryland Medicaid recipients with HIV receiving antiretroviral therapy (ART) after January 1, 1997. SMI was defined as a specialty mental health visit and an ICD-9 diagnosis of (1) schizophrenia or related psychoses, (2) bipolar disorder or (3) major depressive disorder.Cox proportional hazards regression models were used to estimate the hazard ratios for total mortality. Analyses were adjusted for demographic characteristics, percentage of days on ART, outpatient visits, and comorbid medical conditions. Overall, 623 individuals received ART after treatment inception. The total number of deaths was 271, out of which 60 deaths were in the SMI group (38.5%) and 211 in the non-SMI group (45%) (p = 0.05). In multivariable analysis, SMI was not associated with mortality. Increasing age, acquired immunodeficiency syndrome (AIDS) defining illness, renal failure, cerebrovascular disease, congestive heart failure, chronic liver disease, and substance abuse were independently associated with mortality, while increased percent days of HIV medication use and number of outpatient medical visits were associated with improved survival. In this sample, SMI is not associated with earlier death in patients with HIV infection. ART use and primary care engagement among HIV infected individuals are associated with improved survival, irrespective of an SMI diagnosis.
Key words: Human immunodeficiency virus (HIV), serious mental illness (SMI), survival.
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