Impact of Depressive Symptom Severity on Stroke Risk in a US Cohort of People with HIV

Depression is a common psychiatric condition and an independent stroke risk factor among people with HIV (PWH). The impacts of depressive symptom severity on stroke are not clear in PWH.

We studied adult PWH in clinical care at 5 Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites with ≥1 assessment for depressive symptoms (Patient Health Questionnaire-9) from 2010 to 2022. We used Cox models to evaluate (1) associations between time-varying depressive symptom severity and adjudicated incident stroke, serially adjusted for clinical factors and (2) modification of this association by age and sex. Participants were followed from 6 months after first CNICS visit or date the CNICS site began stroke adjudication (baseline) (whichever later) until the first stroke, death, loss to follow-up, last clinic visit, or study end.

Among 13,817 PWH (mean age 45 years, 19% women, 58% non-White race/ethnicity), 23% screened positive for depression at baseline and 173 had an incident stroke during follow-up (mean follow-up 7.6 years). Time-varying depressive symptom severity (per 5 points Patient Health Questionnaire-9 score) was associated with higher stroke risk (adjusted Hazard Ratio 1.16, P = 0.01) with greater impact in PWH <50 years than ≥50 years (interaction P = 0.02) but no significant difference by sex. Adjusting for combinations of sociodemographic, cardiovascular, HIV, and substance use factors only slightly attenuated estimates.

Depressive symptom severity was an independent risk factor for stroke with higher severity depressive symptoms predicting higher stroke risk and greater impact in PWH <50 years. Depression may be a modifiable risk factor for stroke and should be studied further to understand, develop, and target interventions to reduce stroke risk, especially in younger PWH.