PTSD co-morbid with HIV: Separate but equal, or two parts of a whole?

Abstract

Approximately 30 million people currently live with HIV worldwide and the incidence of stress-related disorders, such as post-traumatic stress disorder (PTSD), is elevated among people living with HIV as compared to those living without the virus. PTSD is a severely debilitating, stress-related psychiatric illness associated with trauma exposure. Patients with PTSD experience intrusive and fearful memories as well as flashbacks and nightmares of the traumatic event(s) for much of their lives, may avoid other people, and may be constantly on guard for new negative experiences. This review will delineate the information available to date regarding the comorbidity of PTSD and HIV and discuss the biological mechanisms which may contribute to the co-existence, and potential interaction of, these two disorders. Both HIV and PTSD are linked to altered neurobiology within areas of the brain involved in the startle response and altered function of the hypothalamic-pituitary-adrenal axis. Collectively, the data highlighted suggest that PTSD and HIV are more likely to actively interact than to simply co-exist within the same individual. Multi-faceted interactions between PTSD and HIV have the potential to alter response to treatment for either independent disorder. Therefore, it is of great importance to advance the understanding of the neurobiological substrates that are altered in comorbid PTSD and HIV such that the most efficacious treatments can be administered to improve both mental and physical health and reduce the spread of HIV.

Post-traumatic Stress Disorder Symptoms Among People Living with HIV/AIDS in Rural China

“…There is growing awareness that symptoms of post-traumatic stress disorder (PTSD) are among the most common mental challenges for people living with HIV/AIDS (PLHA) around the world (1). In 2015, there were approximately 36.9 million PLHA worldwide (2).…”

The Psychiatric Impact of HIV

“…1,2 Despite elevated risk, clinicians often fail to adequately diagnose and treat comorbid psychiatric conditions in HIV-infected patients, creating an impediment to effective care. 1–3 Not only do these conditions potentially contribute to cognitive impairments, but mounting evidence suggests that they constitute an independent and substantial health burden.…”

“…1–3 Comorbid substance abuse exemplifies this relationship. It is well documented that substance abuse can increase the probability of HIV exposure and infection (i.e., via injection drug use or risky sexual behavior).…”

“…1,3 The neurobiology of PTSD includes alterations in the hypothalamic pituitary adrenal (HPA) axis and impaired cortical gating of amygdala reactivity. These alterations in neural circuitry are thought to underlie the persistence of intrusive fearful memories, hyperarousal, and nightmares.…”

“…For example, selective serotonin reuptake inhibitors (SSRIs), which are otherwise only partially effective in PTSD patients, also exhibit anti-inflammatory properties that may make these drugs particularly beneficial in an HIV-infected subgroup with comorbid PTSD. 3 …”