BACKGROUND

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.

METHODS

We studied adult PWH in clinical care at five CNICS sites with ≥1 assessment for depressive symptoms (PHQ-9) from 2010-2022. We used Cox models to evaluate: (1) associations between time-varying depressive symptom severity and adjudicated incident stroke, serially adjusted for clinical factors; (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.

RESULTS

Among 13,817 PWH (mean age 45 years, 19% female, 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 PHQ-9 score) was associated with higher stroke risk (aHR 1.16, P=0.01) with greater impact in PWH <50y than ≥50y (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.

CONCLUSIONS

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.