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In HIV, Mental Health Impacts Viral Suppression, But Not Retention in Care

People with HIV experience a high prevalence of mental health (MH) conditions and associated multimorbidity, and those with mental health multimorbidity have lower rates of viral suppression, according to findings presented at the 2023 Conference on Retroviruses and Opportunistic Infections.

“MH conditions are a significant source of morbidity and mortality globally, with a higher burden in people with HIV (PWH),” Keri N. Althoff, PhD, and colleagues wrote. “However, treat-all era differences in HIV outcomes for those with and without MH conditions are understudied and essential for informing the ‘Ending the HIV Epidemic’ (EHE) initiative.”

Dr. Althoff and colleagues examined the prevalence of depression, anxiety, bipolar disorder (BD), and schizophrenia in PWH, as well as differences in HIV care outcomes, among those with and without MH conditions using data from adults in The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Patients were identified using ICD code mapping, and MH multimorbidity was classified as the presence of two or more MH diagnoses. Covariates in adjusted models included age, race/ethnicity, HIV acquisition risk, and cohort.

In HIV, Mental Health Impacts Viral Suppression, But Not Retention in Care
In HIV, Mental Health Impacts Viral Suppression, But Not Retention in Care

Tailoring MH Interventions to Improve HIV Outcomes

The study included 122,896 PWH in HIV care between 2008 and 2018, more than half (55.1%) of whom had one or more MH diagnoses, including 39% with depressive disorders, 28% with anxiety disorders, 10% with BD, and 5% with schizophrenia. The prevalence of depressive and anxiety disorders rose between 2008 and 2018, while rates of BD and schizophrenia remained stable. MH multimorbidity, versus no MH diagnoses, was widespread, impacting 24% of PWH.

Irrespective of MH diagnoses, retention in care declined over time, while viral suppression increased. Between 2016 and 2018, retention in care and the prevalence of viral suppression did not vary among those with a single MH diagnosis. Individuals with MH multimorbidity had a higher incidence of retention in care (estimated crude prevalence ratio, 1.04) but a lower prevalence of viral suppression (estimated crude prevalence ratio, 0.98) compared with those with no MH diagnoses.

“Although retention was similar to people without MH diagnoses, viral suppression was lower in those with MH multimorbidity,” Dr. Althoff and colleagues wrote. “To achieve EHE goals of viral suppression, tailored interventions for PWH with MH multimorbidity may be needed.”


Mental Health Disorders in People With HIV and the Effects on the HIV Care Continuum


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