Posttraumatic stress disorder and its associations with morbidity and mortality among veterans with HIV

Objectives: Posttraumatic stress disorder (PTSD) may increase the risks of adverse clinical outcomes for Veterans with HIV (VWH) receiving care in the Department of Veterans Affairs (VA). Objectives were to (1) estimate the associations between PTSD and morbidity and mortality; (2) measure effect modification by number of deployments and combat exposure; and (3) examine how these associations vary over time. Design: In this prospective cohort study of all VWH on antiretroviral therapy (ART) who deployed to Iraq and Afghanistan and receive care in the VA (n = 3,206), patients entered at HIV diagnosis and were censored in December 2022, totaling 20,121 person-years of follow-up. Methods: Marginal structural Cox models were fitted with a time-dependent exposure, adjusted for time-independent and -dependent confounding and informative censoring. Results: PTSD increased the risks (adjusted hazard ratio, [95% CI]) for AIDS by 11% (1.11 [1.00, 1.23]), chronic kidney disease by 21% (1.21 [1.02, 1.43]), chronic obstructive pulmonary disease by 46% (1.46 [1.10, 1.92]), multimorbidity by 49% (1.49 [1.24, 1.81]), cardiovascular disease by 57% (1.57 [1.25, 1.97]), and arthritis two-fold (1.95 [1.76, 2.15]). PTSD was not associated with asthma, cancer, cerebrovascular disease, diabetes mellitus, liver disease, or all-cause mortality. Associations of PTSD were most pronounced in the first decade post-diagnosis, followed by gradual waning yet still elevated risks. Conclusions: It is recommended that providers who work with VWH consider adopting a trauma-informed model of HIV care and that providers screen Veterans for PTSD, so that their unique trauma history can help guide medical decisions and treatment.