HIV Outcomes Could Improve by Integrating Treatment of Comorbid Mental Illness

Although individuals with HIV are living longer due to antiretroviral drug therapy (ART), many of them also suffer from psychological disorders such as depression, neurocognitive disorders, and substance use disorders. An international team from the United States, Haiti, Uganda, and Tanzania recently released the first of a five-part policy report on improving HIV patient outcomes by integrating treatment for HIV and comorbid mental illness. According to the authors, some mechanisms link HIV with mental illness. These include social conditions under which patients live, fears about employment and housing, food security, and social stigma. Also, HIV can affect the central nervous system, causing long-term cognitive problems that ART may not help and place the patient at additional risk of contracting other infections.

According to the authors, scientific literature describes all of these problems but does not have much clinical data on programs to integrate the two types of diseases. The authors see potential in treating ailments such as depression and alcohol abuse disorder along with HIV, and beginning ART earlier to prevent some of the neurocognitive impairment. They also recommend integrating screenings and brief psychotherapeutic interventions with HIV care. They contend that the case for integrating mental health care into medical treatment is supported by good studies and that such integration may increase ART effectiveness for patients in developing countries who may not access mental health care separately, even if it is free.

The full report, "Grand Challenges: Improving HIV Treatment Outcomes by Integrating Interventions for Co-Morbid Mental Illness," was published in the journal PLoS Med (2013; doi: 10(5): e1001447).