CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

impacted depression and how the depression epidemic has impacted the HIV pandemic in Nyanza, Kenya, a geography where both conditions are prevalent. Methods: We adapted a previously validated agent-based network transmission model calibrated to age- and sex-specific prevalence of HIV and coverage of treatment and prevention services. We augmented this model to include major depressive disorder. The model was calibrated to the age- and sex-specific incidence, recovery, and relapse rates of major depressive disorder in Kenya. Calibration was applied to a primary scenario, in which we included the following interactions between HIV and depression based on rapid review of literature: HIV increases incidence of depression (2x); depression increases HIV acquisition rate (1.6x); depression interferes with the HIV care continuum (2x delays to testing, 1.2x reduction in adherence to treatment, and 2x higher rates of treatment discontinuation). In a counterfactual scenario, we removed all interactions between HIV and depression. We estimated the number of episodes of depression, new HIV cases, and HIV-related deaths over 1985–2025. Results: In the primary scenario, we estimated 1.24 million new HIV infections, 0.66 million HIV deaths, and 17.7 million episodes of depression in western Kenya over 1985–2025. We found a 9.96% (95% CI: 9.84%–10.1%) increase in episodes of depression attributable to HIV; a 9.18% (95% CI: 8.93%–9.44%) increase in new HIV cases attributable to depression; and a 10.5% (95% CI: 10.1%–10.8%) increase in HIV-related deaths attributable to depression. Sensitivity analysis is ongoing to identify interactions most strongly responsible for these effects and that contribute the greatest uncertainties. Conclusion: Our findings suggest interactions between depression and HIV have substantially exacerbated both epidemics. Research is needed to more precisely quantify strengths of the interactions and how they differ across populations and settings. 1050 Prevalence of Diagnosed and Undiagnosed Depression Among US Adults With HIV Linda Beer, Linda J. Koenig, Yunfeng Tie, Xin A. Yuan, Jennifer Fagan, Kate Buchacz, John Weiser Centers for Disease Control and Prevention, Atlanta, GA, USA Background: People with HIV are disproportionately affected by depression. Effectively diagnosing and treating depression could improve quality of life (QoL) and HIV outcomes. We used data from CDC's Medical Monitoring Project (MMP) to report nationally representative estimates of diagnosed and undiagnosed depression among U.S. adults with HIV (PWH). Methods: During 6/2021–5/2022, MMP collected interview data on depression symptoms consistent with a diagnosis using the Patient Health Questionnaire (PHQ-8) and depression diagnoses from medical records of PWH (Figure). We report weighted percentages and prevalence ratios (PRs) with predicted marginal means and 95% confidence intervals (CIs) to quantify differences between groups on key social and health factors. Results: Overall, 34% of PWH experienced any depression (either by diagnosis or PHQ-8); of these, 26% had symptoms but no diagnosis (undiagnosed depression), 19% had both diagnosis and symptoms, and 55% had a diagnosis without symptoms (Figure). Among those with depression, cisgender men (PR: 1.34, CI:1.04-1.72) and transgender persons (PR: 1.77, CI:1.07-2.90) were more likely than cisgender women to have undiagnosed depression, as were those with a disability (PR: 1.52, CI:1.19-1.94) and food insecurity (PR: 1.67, CI:1.37-2.03) than those without. Unemployed persons (PR: 1.62, CI:1.11-2.38) were more likely than employed persons to have diagnosed depression with symptoms, as were those with a disability (PR:2.78, CI:2.13-3.64), who experienced housing instability/homelessness (PR: 1.37, CI:1.06-1.77), food insecurity (PR:1.46, CI:1.12-1.90), or discrimination in HIV care (PR: 1.71, CI:1.30-2.23) than those without. HIV stigma was higher with nonoverlapping CIs among the undiagnosed (median score, range 0-100: 40.4, CI:34.6-46.2) and diagnosed with symptoms (43.1, CI:36.2-50.0) than those diagnosed without symptoms (28.0, CI:26.1-30.0). Those with symptoms (undiagnosed or diagnosed) were less likely than those diagnosed without symptoms to be dose adherent (PR: 0.88, CI:0.78-0.98; PR: 0.73, CI:0.60-0.89) or have sustained viral suppression (PR: 0.62, CI:0.54-0.72; PR: 0.91, CI:0.82-1.00) and were more likely to have unmet needs for mental health services (PR: 2.38, CI:1.62-3.51, PR: 2.03, CI:1.45-2.83). Conclusion: One-third of PWH experienced depression; nearly half of them were undiagnosed or still experiencing considerable symptoms. Expanding universal screening and high-quality treatment for depression could improve QoL and HIV outcomes.

1051 Trends in Suicide-Related Emergency Department Visits Among People With and Without HIV in Bronx, NY Chloe Roske 1 , Caitlin Hills 1 , Wenzhu B. Mowrey 1 , Yingchen Xu 1 , Aaron S. Breslow 1 , Atul K. Bhattiprolu 1 , Ava Erulker 1 , Grishma Patel 1 , Joan W. Berman 1 , Anjali Sharma 1 , Vilma Gabbay 2 , David B. Hanna 1 1 Albert Einstein College of Medicine, Bronx, NY, USA, 2 University of Miami, Miami, FL, USA Background: People living with HIV (PWH) are at elevated risk for suicidality (i.e., suicidal ideation, plans, attempts), though little is known about population-specific factors driving potential disparities in Emergency Department (ED) visits in the context of suicide. Using longitudinal data from a large Bronx, NY health system, we measured trends and disparities in suicide related ED visits between PWH (N=7,903) and people without HIV (N=560,977). Methods: Using the Einstein-Rockefeller-CUNY CFAR's Clinical Cohort Database, we identified all ED visits among patients age 17+ years at 4 EDs in the Montefiore Health System between 2016 and 2022, and determined suicide related visits using ICD-10-CM diagnosis codes for suicidal ideation/behavior. We measured rates of suicide-related visits by HIV status. Rates were annualized per 1,000 ED visits, age-standardized to the 2000 US Standard Population and stratified by gender, age, race/ethnicity and HIV transmission factor. Results: Among 1,760,143 unique ED visits (40,475 among PWH) between 2016 2022, 8,994 (506 among PWH) were suicide-related. The overall rate of suicidal ideation/behavior among PWH was 14.9/1,000 ED visits (95% CI 13.3-16.4), compared with 5.2/1,000 (95% CI 5.1-5.3) among those without HIV. Rates were consistently higher among PWH versus those without HIV across gender and age categories (Figure). Among PWH, the highest rates were observed among those age 17-39 years (25.6/1,000, 95% CI 22.4-28.9), cisgender men (18.5/1,000, 95% CI 16.4-20.7, vs cisgender women, 6.6/1,000, 95% CI 5.0-8.3), and non-cisgender individuals (30.0/1,000, 95% CI 16.8-45.0). Before the COVID-19 pandemic, both the annual number and rate of suicide-related ED visits had increased steadily over time among PWH, from N=39 (7.8/1,000) in 2016 to N=74 (16.7/1,000) in 2019. Trends showed a further increase as COVID-19 became established, to N=86 (27.4/1,000) in 2020, particularly among PWH age 17-39, before decreasing in 2021 and 2022. Temporal increases in suicidal ideation/behavior were less pronounced among people without HIV. Conclusion: Suicide-related visits were nearly 3-fold higher among PWH compared with those without HIV in this large, urban ED setting, and increased differentially over time, even after accounting for temporal changes associated with the COVID-19 pandemic. Younger PWH and transgender individuals may be at particular risk for suicidality; more research into associated factors is needed to help info.

Poster Abstracts

1052 Progress Toward Achieving National Goals for Improved Quality-of-Life Among Black Women With HIV Jerris L Raiford , Yunfeng Tie, Xin A.Yuan, Kathy Byrd, Kate Buchacz, Linda Beer Centers for Disease Control and Prevention, Atlanta, GA, USA

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