The Dual Burden of HIV Infection and First-Episode Psychosis in Africa

Abstract

A systematic review and meta-analysis was conducted to synthesize data on HIV prevalence in individuals with first-episode psychosis (FEP) and to provide an overview of the association of HIV with clinical variables of FEP. Electronic databases were searched for quantitative studies published from January 1986 to November 2019. Meta-analyses were undertaken to calculate the pooled HIV/FEP proportion based on random effects modeling with inverse variance method. Seven HIV/FEP studies from sub-Sahara Africa (SSA) met inclusion criteria. The prevalence of HIV in FEP ranged from 24% to 40%, and FEP in people living with HIV (PLWHIV) ranged from 17% to 29%. The pooled proportion of HIV in FEP was 26% (95% confidence interval [CI], 10%-43%), with significant heterogeneity (n = 3, I 2 = 89%, p < 0.01), and of FEP in PLWHIV was 23% (95% CI, 15%-32%), without significant heterogeneity (n = 3, I 2 = 0%, p = 0.43). There are concerning levels of HIV and FEP comorbidity in SSA, necessitating an integrated health care service.

HIV prevalence and access to HIV testing and care in patients with psychosis in South Africa

“…1 The prevalence in this study is also lower than the estimated 26% rate in the recent systematic review of HIV prevalence in FEP in Africa. 7 Hopefully, the results of this study suggest that HIV prevalence is decreasing in those who are mentally ill and moving towards the general population rates, but this will need to be explored further in larger prospective studies.…”

“…The study reported an HIV prevalence range from 23.8% to 39.6%, while the meta-analysis of their data reported the pooled proportion of HIV in patients living with FEP as 26% (95% confidence interval [CI] 10–42). 7 …”

“…The study reported an HIV prevalence range from 23.8% to 39.6%, while the meta-analysis of their data reported the pooled proportion of HIV in patients living with FEP as 26% (95% confidence interval [CI] 10-42). 7 As effective antiretroviral treatments (ARTs) are now available, it is critical to diagnose HIV infection early in the mentally ill, especially as they are a high risk population. 8 In the struggle against HIV and aquired immunodeficiency syndrome (AIDS), the United Nations (UN) and Background: Human immunodeficiency virus (HIV) and psychosis share a complex bidirectional relationship, with people living with HIV being at increased risk of psychosis and those with psychosis at increased risk of HIV.…”

Sexually transmitted infections, sexual life and risk behaviours of people living with schizophrenia: systematic review and meta-analysis

“…A previous meta-analysis examining the prevalence of HIV seropositivity among patients with first-episode psychosis patients in the African continent found an even greater pooled prevalence of 26%, which they hypothetically linked to longer duration of untreated schizophrenia, low access to health services and high prevalence of infection in the continent. 105 On the other hand, and more encouragingly, the prevalence of HBV and HCV appears to be lower according to more recently published articles (and in the case of HCV, for samples with younger mean age). Global trends for hepatitis B and C have shown a positive evolution over the last decades, 106 especially with the appearance of direct-acting antiviral treatments for HCV.…”