The Prevalence of Mental Health Disorders in people with HIV and the effects on the HIV Care Continuum

Abstract

ObjectiveTo describe the prevalence of diagnosed depression, anxiety, bipolar disorder, and schizophrenia in people with HIV (PWH) and the differences in HIV care continuum outcomes in those with and without mental health disorders (MHD).DesignObservational study of participants in the NA-ACCORD.MethodsPWH (≥18 years) contributed data on prevalent schizophrenia, anxiety, depressive, and bipolar disorders from 2008-2018 based on ICD code mapping. MH multimorbidity was defined as having ≥ 2 MHD. Log binomial models with generalized estimating equations estimated adjusted prevalence ratios (aPR) and 95% confidence intervals for retention in care (≥ 1 visit/year) and viral suppression (HIV RNA ≤ 200 copies/mL) by presence vs. absence of each MHD between 2016-2018.ResultsAmong 122,896 PWH, 67,643 (55.1%) were diagnosed with ≥ 1 MHD: 39% with depressive disorders, 28% with anxiety disorders, 10% with bipolar disorder, and 5% with schizophrenia. The prevalence of depressive and anxiety disorders increased between 2008-2018, while bipolar disorder and schizophrenia remained stable. MH multimorbidity affected 24% of PWH. From 2016-2018 (N=64,684), retention in care was marginally lower among PWH with depression or anxiety, however those with MH multimorbidity were more likely to be retained in care. PWH with bipolar disorder had marginally lower prevalence of viral suppression (aPR=0.98 [0.98-0.99]) as did PWH with MH multimorbidity (aPR=0.99 [0.99-1.00]) compared with PWH without MHD.ConclusionThe prevalence of MHD among PWH was high, including MH multimorbidity. Although retention and viral suppression were similar to people without MHD, viral suppression was lower in those with bipolar disorder and MH multimorbidity.

The projected prevalence of comorbidities and multimorbidity in people with HIV in the United States through the year 2030

“…The prevalence of having depression, anxiety, stage ≥3 CKD, dyslipidemia, type 2 diabetes, hypertension, cancer (all types), myocardial infarction (MI), and ESLD (at or prior to ART initiation) was estimated at the time the simulated person initiated ART ( Figure 1 ). 24,30,39–41 Incidence of each comorbidity was estimated as a function of age, CD4 at ART initiation (cells/μL), time since ART initiation, disengagement from care, change in BMI in the first 2 years after ART initiation, BMI 2 years after ART initiation, smoking, HCV co-infection, and the presence of the other comorbidities for simulated persons in the years after ART initiation ( Supplement Table S2 ). Finally, mortality was estimated for simulated persons as a function of individual-level attributes, existing risk factors, and present comorbidities, and was estimated separately for those (1) engaged and (2) disengaged from care (≥2 years without CD4 or HIV RNA measurement) and in each of the 15 sub-groups using observed NA-ACCORD data from 2009-2017 ( Supplement Table S3 ).…”

“…1). 24,30,[39][40][41] Incidence of each comorbidity was estimated as a function of age, CD4 at ART initiation (cells/µL), time since ART initiation, disengagement from care, change in BMI in the first 2 years after ART initiation, BMI 2 years after ART initiation, smoking, HCV co-infection, and the presence of the other comorbidities for simulated persons in the years after ART initiation (Supplement Table S2).…”

People who living with HIV/AIDS also have a high prevalence of anxiety disorders: a systematic review and meta-analysis

“…As for PLWHA, anxiety disorders are one of the most common psychiatric illnesses in HIV-associated mental disorders (7,8). Overall, different studies have reported the incidence of anxiety disorders among people living with HIV/AIDS ranging from 0.6% to 68.2% (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In the general population, anxiety is a risk factor for cognitive impairment (19), it can adversely affect the brain (20), and also it has a negative impact on disorders other than those related to the neuropsychiatric system (21).…”