Researchers in Sweden accessed a database containing medical information collected from about 3,500 HIV-positive people and, for comparison, medical information from about 2.1 million HIV-negative people, all living in the greater Stockholm region. The researchers sought to compare rates of mental health issues in both populations. For their analysis, the researchers focused on diagnoses that had been made and placed in participants' medical records between 2007 and 2014.
The researchers found that HIV-positive people were significantly more likely to be diagnosed with one of several mental health conditions. The Swedish study's findings are similar to studies done in other countries. In high-income countries in the current era, poor mental health is linked to reduced quality of life and survival among HIV-positive people. The Swedish study underscores the need to screen HIV-positive people for mental health issues and offer treatment.
A Shifting Focus
Today, the widespread availability of potent combination anti-HIV therapy (ART) in high-income countries has meant that compared to the 1980s or early 1990s AIDS-related infections and deaths are generally much less common. Furthermore, a young adult who is infected today, and who is diagnosed and initiates ART shortly thereafter, and who takes ART every day exactly as prescribed and directed, and who achieves and maintains an undetectable viral load, and who does not have other pre-existing health issues is expected to live into his or her senior years. As a result, researchers are paying more attention to the factors that impede a person's ability to live longer despite the use of ART.
Researchers compared mental health diagnoses between 3,582 HIV-positive people (2,448 men and 1,134 women) and approximately 2.1 million HIV-negative people living in the greater Stockholm region.
The specific mental health conditions reviewed were as follows:
- anxiety and related conditions
- bipolar illness
- post-traumatic stress disorder and related conditions
- substance dependency
The research team also acquired socio-economic data on participants and did analyses by neighbourhood.
In general, the researchers found that mental health conditions "were more common among individuals with [HIV]" compared to people without HIV. However, an exception was anxiety (and related conditions), which were not more common among HIV-positive women compared to HIV-negative women.
The Swedish team reminds doctors and nurses of the need to screen their patients for mental health issues, including problematic substance use, and, if a mental health issue is diagnosed, to offer treatment. They also stated that it might be necessary for some physicians to collaborate with other healthcare providers -- counsellors, psychologists, psychiatrists, pharmacists -- when looking after patients with mental health conditions and HIV.
Jallow A, Ljunggren G, Wändell P, et al. HIV-infection and psychiatric illnesses -- A double-edged sword that threatens the vision of a contained epidemic: The Greater Stockholm HIV Cohort Study. Journal of Infection. 2016; in press.