HIV and Psychiatric Illness Comorbidity

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Both men and women with HIV were more likely to experience comorbid psychiatric conditions than their peers without an HIV diagnosis.
Both men and women with HIV were more likely to experience comorbid psychiatric conditions than their peers without an HIV diagnosis.

People with HIV are more likely to experience comorbid psychiatric conditions than those without an HIV diagnosis, according to research published in the Journal of Infection.1

Axel C. Carlsson, PhD, of the Division of Family Medicine, Department of Neurobiology and the Centre for Family and Community Medicine at the Karolinska Institutet, and colleagues conducted a longitudinal review of the Greater Stockholm HIV Cohort, comprised of patients diagnosed with HIV between 2007-2014, to explore psychiatric comorbidities in patients with HIV, including psychoses, bipolar disorders, depression, anxiety disorders, trauma related disorders, and drug dependency.

Among the total population of Stockholm County (n=2.21 million), total prevalence of HIV was 0.16% (0.10% female, 0.22% male), with the highest number of HIV diagnoses among women 18-44 years of age and men 45-64 years of age.

Among women without HIV, 17.7% were diagnosed with a psychiatric illness—psychoses, bipolar disorders, depression, anxiety disorders, trauma-related disorders, or drug dependency disorders—compared to 33.2% of women with an HIV diagnosis; 10.2% of men without HIV were diagnosed with psychiatric illness, compared to 33.8% of ,men with HIV. In an age adjusted model of women and men with HIV diagnosis compared to women and men without, the most common co-morbid diagnoses among both men and women was drug dependency disorder (Table 1, below, adapted from Dr Carlsson et al1, provides odds ratios [OR] and 95% confidence interval [CI] for psychiatric comorbidities. 

Table 1. Odds ratios of psychiatric comorbidities in women and men with HIV (2013-2014).

Women Men
Psychoses OR: 4.21; 95% CI, 2.78-6.37 OR: 2.43; 95% CI, 1.70-3.50
Bipolar disorders OR: 2.39; 95% CI, 1.43-3.91 OR: 2.68; 95% CI, 1.80-3.97
Depression OR: 1.40; 95% CI, 1.14-1.73 OR: 3.33; 95% CI, 2.91-3.80
Anxiety disorders OR: 1.09; 95% CI, 0.86-1.38 OR: 2.31; 95% CI, 1.96-2.71
Trauma-related disorders OR: 1.38; 95% CI, 1.07-1.78 OR: 2.95; 95% CI, 2.43-3.58
Drug dependency disorders OR: 6.48, 95% CI, 5.13-8.19 OR: 4.66; 95% CI, 4.05-5.36

Additional adjustment for neighborhood socioeconomic status yielded similar results for those with drug dependency disorders.

“[People with HIV] are more frequently diagnosed with psychiatric illness and drug abuse,” the researchers wrote. “Previous studies have shown that the association between HIV infection and psychiatric problems may go in both directions; psychiatric complications are common, and pre-existing psychiatric illness is a risk factor for acquisition of the virus.”

The researchers note that their findings are in line with earlier studies that also report a high prevalence of psychiatric disorders among people with HIV, citing potential explanations such as anxiety resulting from diagnosis, stigmatization among peers, and the burden of lifelong antiretroviral therapy.

“To obtain the optimal value of [antiretroviral therapy] in HIV management, it is important to address the co-occuring psychiatric illnesses in HIV populations,” Dr Carlsson and colleagues concluded. “Clinicians who prescribe antiretroviral therapy (ART) should screen patients for psychiatric illness, including substance use.

“As psychiatric illness may contribute to poor adherence and therapeutic failure, an improved understanding of psychiatric conditions combined with innovative and comprehensive approaches are imperative to reduce disparities among individuals living with HIV.”

Reference

  1. Jallow A, Ljunggren G, Wandell P, Whalstrom L, Carlsson AC.HIV-infection and psychiatric illness—a double edged sword that threatens the vision of a contained epidemic. The greater Stockholm HIV cohort study.J Infection. 2016; doi: 10.1016/j.jinf.2016.09.009

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