Patterns in Mental Health Symptoms, Substance Use, and Viral Suppression in People with HIV: A Clustering Analysis.

Journal: AIDS and behavior
Published Date:

Abstract

Mental health conditions and substance use are prevalent among people with HIV (PWH), are correlated with one another, and associate with viral non-suppression independently; their joint association with viral non-suppression may be under-studied because of data sparsity. We conducted a machine learning-based clustering analysis to characterize groups of patient-reported mental health symptoms and substance use based on their relationship with HIV viral suppression. Participants in the Johns Hopkins HIV Clinical Cohort reported symptoms of depression, anxiety, and post-traumatic stress, and recent use of alcohol, cocaine, amphetamine, non-prescribed opioids, and cannabis (2013-2023). We fit a random forest model with the viral suppression status as the outcome against self-reported items as predictors and used a forest-derived similarity measure to group participants into three clusters. The cluster with the lowest viral suppression rate (74.5%) had the highest depression symptom score (median score 4, interquartile interval [IQI] 1-8) and anxiety symptom score (median score 2, IQI 0-7) along with the greatest prevalence of recent cocaine (99.9%) and opioid (28.0%) use. The cluster with the highest HIV viral suppression rate (81.1%) had the lowest depression symptom score (median 1, IQI 0-4) and anxiety symptom score (median 0, IQI 0-2) and lowest proportion of recent cocaine (0%) and opioid (2.5%) use. Clinically meaningful groups of PWH with heterogenous mental health and substance use characteristics were formed using a machine learning-based clustering approach. PWH with mental health symptoms and substance use represent an important subpopulation for interventions to improve antiretroviral treatment outcomes.

Authors

  • Y Joseph Hwang
    Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street 2-300, Baltimore, MD, 21287, USA. yhwang19@jhmi.edu.
  • Catherine R Lesko
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Jarratt D Pytell
    Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
  • Oluwaseun Falade-Nwulia
    Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street 2-300, Baltimore, MD, 21287, USA.
  • Joyce L Jones
    Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street 2-300, Baltimore, MD, 21287, USA.
  • Jeanne C Keruly
    Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street 2-300, Baltimore, MD, 21287, USA.
  • LaQuita N Snow
    Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street 2-300, Baltimore, MD, 21287, USA.
  • Richard D Moore
    Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street 2-300, Baltimore, MD, 21287, USA.
  • Anthony T Fojo
    Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street 2-300, Baltimore, MD, 21287, USA.

Keywords

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