A Retrospective Analysis Exploring the Impact of Psychiatric Comorbidities on the Time to Initiate HIV Treatment

Background: Timely initiation of antiretroviral therapy (ART) is critical for optimal HIV management. However, psychiatric comorbidities may influence treatment adherence, healthcare engagement, and overall outcomes. This retrospective cohort study explored the impact of major depressive disorder (MDD), generalized anxiety disorder (GAD), and schizophrenia on the time to initiation of ART for HIV management. Methods: Using TriNetX, a de-identified database encompassing 66 U.S. healthcare organizations, adults aged 18 and older with an HIV diagnosis were identified through insurance billing codes. Participants were categorized into four groups based on psychiatric history: MDD, GAD, schizophrenia, or no psychiatric diagnosis. Each psychiatric group was propensity score–matched to a control group without a prior psychiatric history to minimize bias. Measures of association and Kaplan-Meier survival analyses were conducted to assess time to ART initiation. Results: There was an observed association between having a psychiatric diagnosis prior to acquiring HIV and a higher likelihood of initiating ART, compared to controls. Additionally, those with a psychiatric diagnosis were observed to have initiated ART sooner. The median time to ART initiation was 136 days for MDD, 129 days for GAD, and 163 days for schizophrenia, compared to 312, 229, and 302 days in their respective control groups. Conclusion: Individuals with psychiatric comorbidities were more likely to begin ART earlier than those without a psychiatric condition. This may reflect increased healthcare engagement among patients with established psychiatric care, highlighting the importance of integrated behavioral and medical health services for improving HIV treatment outcomes.