Prevalence and change in psychiatric disorders among perinatally HIV-infected and HIV-exposed youth

Abstract

As the pediatric HIV epidemic in resource-rich countries evolves into an adolescent epidemic, there is a substantive need for studies elucidating mental health needs of perinatally HIV-infected (PHIV+) youth as they transition through adolescence. This article examines the role of perinatal HIV infection in influencing mental health by comparing changes in psychiatric disorders and substance use disorders (SUD) in perinatally HIV-infected (PHIV+) and perinatally HIV-exposed, but uninfected (PHIV−) youth over time. Participants were recruited from four medical centers in New York City. Individual interviews were administered at baseline and 18-month follow-up to 166 PHIV+ and 114 PHIV-youth (49% male, age 9–16 at baseline). Youth psychiatric disorder was assessed using the caregiver and youth versions of the Diagnostic Interview Schedule for Children (DISC-IV). Over two-thirds of participants met criteria for at least one psychiatric disorder at either baseline or follow-up, with few group differences. Among PHIV+ youth, there was a significant decrease in the prevalence of any psychiatric disorder, as well as anxiety disorders specifically over time, while prevalence of any psychiatric disorder among PHIV− youth remained the same and mood disorders increased. Rates of SUD were low in both groups, increasing slightly by follow-up. PHIV+ youth reported more use of mental health services at follow-up. CD4 count and HIV RNA Viral Load were not associated with presence or absence of disorder at either time point. In conclusion, among PHIV+ and PHIV− youth, rates of psychiatric disorder were high, even compared to other vulnerable populations, suggesting that factors other than perinatal HIV infection may be important determinants of mental health. PHIV+ youth were more likely to improve over the observation period. The data underscore the critical need for mental health interventions for both PHIV+ and PHIV− youth.

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].…”

Perinatally infected adolescents living with human immunodeficiency virus (perinatally human immunodeficiency virus)

“…The results showed that the performance of the PHIV youths was poorer compared to the control group, which consisted of agematched HIV-uninfected volunteers [44] . In regard to mental health, the incidence of psychiatric disorders is higher among PHIV adolescents and uninfected youths belonging to HIV-infected families compared to the general population [45][46][47] . Several studies found that up to 70% of such adolescents meet psychiatric diagnostic criteria.…”

“…Several studies found that up to 70% of such adolescents meet psychiatric diagnostic criteria. Some authors found correlations between diagnosis in adolescents and psychiatric disorders among their caretakers [45][46][47] .…”