Interaction Effect of Depression and Hypertension on Nephrotoxicity Among Persons Living With HIV: A Cross-Sectional Study

Background: The goal of antiretroviral therapy will not be achieved without addressing Human Immunodeficiency Virus (HIV) comorbidities, including depression, hypertension, and nephrotoxicity among people living with HIV (PLWH). This study was conducted to assess the interaction effect of depression and hypertension on nephrotoxicity among PLWH. Methods: The study employed a cross-sectional study design. Data were collected from May to June 2022. The main outcome was nephrotoxicity, while depression and hypertension were considered as exposure factors. Confounders were identified through the directed acyclic graph and were controlled using the propensity score matching procedure. We estimated the causal association from the interactions by using weighted logistic regression. Results: The study involved 416 PLWH with ages ranging from 19 to 80 years (mean standard deviation was 49.32 ± 10.43 years). The majority (79.09%) of the participants involved were females. The prevalence of depression, hypertension, and nephrotoxicity was 21.87% (95% CI = 18.15–26.12), 36.30% (31.80–41.05), and 33.65% (29.26–38.35), respectively. Among participants with both depression and hypertension, analysis showed a substantial increase in the odds of nephrotoxicity. The proportion of the combined effect due to interaction was approximately 71% (63–77), and the excess risk due to interaction was positive (RERI = 1.87; 1.46–2.28). On the multiplicative scale, when both depression and hypertension are present, the risk of nephrotoxicity tripled (effect = 3.42; 2.70–4.14). Having depression raises the likelihood of nephrotoxicity by 55% (aOR = 1.55; 1.35–1.76) among PLWH with hypertension. Among PLWH with depression, the odds of nephrotoxicity increased by over twofold due to hypertension (aOR = 2.12; 1.83–2.42). Conclusion: The presence of both depression and hypertension raises the likelihood of nephrotoxicity much more than either condition alone. The findings revealed a synergistic effect, highlighting the need for integrated care that addresses both mental health and cardiovascular risks in HIV treatment.