Co-Occuring Psychiatric Symptoms in Children Perinatally Infected With HIV and Peer Comparison Sample

Abstract

Objective-To compare the rates of psychopathology in youths perinatally infected with HIV (N = 319) with a comparison sample of peers (N = 256) either HIV-exposed or living in households with HIV-infected family members.Method-Participants were randomly recruited from 29 sites in the United States and Puerto Rico and completed an extensive battery of measures including standardized DSM-IV-referenced ratings scales.Results-The HIV+ group was relatively healthy (73% with CD4% >25%), and 92% were actively receiving antiretroviral therapy. Youths with HIV (17%) met symptom and impairment criteria for the following disorders: attention-deficit/hyperactivity disorder (12%), oppositional defiant disorder (5%), conduct disorder (1%), generalized anxiety disorder (2%), separation anxiety disorder (1%), depressive disorder (2%), or manic episode (1%). Many youths with HIV (27%) and peers (26%) were rated (either self-or caregiver report) as having psychiatric problems that interfered with academic or social functioning. With the exception of somatization disorder, the HIV+ group did not evidence higher rates or severity of psychopathology than peers, although rates for both groups were higher than the general population. Nevertheless, self-awareness of HIV infection in younger children was associated with more severe symptomatology, and youths with HIV had higher lifetime rates of special education (44 vs 32%), psychopharmacological (23 vs 12%), or behavioral (27 vs 17%) interventions. Youth-caregiver agreement was modest, and youths reported more impairment. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusion-HIV infection was not associated with differentially greater levels of current psychopathology; nevertheless, investigation of relations with developmental changes and specific illness parameters and treatments are ongoing. Index termsHIV; ADHD; psychopathology; children; Child and Adolescent Symptom Inventory-4R; Youth's Self-Report Inventory-4R; Child's Self-Report Inventory-4With the advent of life-prolonging antiretrovirals, HIV infection has become a chronic disease and is no longer the certain death sentence in children that it was in the preantiretroviral era. However, HIV does not just affect the immune system, it is also neurotropic, suggesting its effects may be seen differently at different developmental stages. Often, the first manifestation of HIV before the widespread availability of highly active antiretrovirals (HAART) was progressive encephalopathy. In the post-HAART era, there is a growing literature suggesting that neuropsychiatric illnesses may also be a manifestation of HIV. Compounding the direct and indirect effects of HIV on these growing brains are perhaps the long-term effects of antiretroviral therapies and various stressors (biologic and societal) associated with presence of HIV in the family unit.Several investigators have reported that many children and adolescents with HIV have or meet clinical criteria for psychiatric disorder, particularly att...

Behavioral Health Risks in Perinatally HIV-Exposed Youth: Co-Occurrence of Sexual and Drug Use Behavior, Mental Health Problems, and Nonadherence to Antiretroviral Treatment

“…These latter two differences concur with a number of previous studies of this population (see Discussion). [4][5][6] Prevalence of behavioral health risks (excluding adherence) Table 2 summarizes the proportion of PHIV + and PHEU youth who met each of the study defined criteria for each of the behavioral health risks. For PHIV + youth and PHEU youth, the most frequently reported behavioral health risk was a mental health problem (26% PHIV + and 33% PHEU), most frequently with a BSI score in the at-risk or clinically significant range.…”

“…A number of other studies have also shown that this population of youth is at high risk for mental health problems as well as sexual risk behavior. 6,41 Unfortunately, HIV-exposed but uninfected youth are often difficult to identify and monitor. They are not followed in comprehensive HIV care clinics, unless they enroll in a limited number of studies such as this one.…”

“…The few existing studies with PHIV + youth indicate high rates of psychiatric problems [4][5][6] and the emergence of sexual risk behaviors, including early onset of sexual intercourse and sex without condoms, as well as substance use problems during adolescence. [7][8][9][10] Furthermore, studies suggest that a significant percentage of PHIV + youth fail to adequately adhere to antiretroviral treatment (ART) regimens, resulting in increased viral load and potentially the development of treatment resistant strains of the virus.…”

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

“…Whether these are higher than in other patient groups with chronic medical conditions, HIV‐exposed but uninfected siblings or well‐matched healthy controls is yet to be fully determined 222, 224, 225, 226. Nevertheless, it is essential that the multidisciplinary team at least monitor for symptoms and signs of psychological distress and mental health disorder, as children progress into adolescence and young adult life.…”

Growing up HIV-positive in Uganda: “psychological immunodeficiency”? A qualitative study

“…attention deficit hyperactivity disorder), and emotional disorders (e.g. anxiety and depressive disorders) [3][4][5][6][7][8] Psychiatric disorders among children and adolescents with HIV leads to psychological distress and impaired quality of life, increased stigma and isolation and may lead to negative clinical and behavioral outcomes. Despite antiretroviral therapy improving the survival of HIV-infected children, the mental health problems of these children and adolescents have had less attention [9].…”