People living with HIV (PLWH) in the UK are far more likely to experience mental illness compared with their non-HIV counterparts, a new study published in The Lancet HIV has found.
HIV and mental health are believed to have a bidirectional relationship, with poor mental health being a risk factor for HIV infection, as well as a potential consequence of it. Co-morbid mental illness is a major concern for those caring for PLWH, as it can reduce the compliance to antiretroviral therapy and retention in HIV care, thereby resulting in inadequate virological control and deteriorating immune suppression.
Population-Based Cohort Study
Researchers conducted a population-based cohort study using data from the IQVIA medical research database, a nationally representative UK database of primary care electronic health records, dated from 2000 to 2020. A total of 7167 adults living with HIV without mental illness at baseline were matched with an equal number of adults without HIV using propensity score matching. Primary outcome was composite mental illness, which included depression, anxiety, or severe mental illness.
The incidence rate of composite mental illness was significantly higher for PLWH compared with people without HIV (19.6 vs 12.1 per 1000 person-years). PLWH vs those without HIV had a higher incidence rate of depression (15.4 vs 7.9 per 1000 person-years), anxiety (7.2 vs 5.0 per 1000 person-years), and severe mental illness (1.6 vs 0.6 per 1000 person-years).
After adjusting for confounders, PLWH had a significantly higher risk of incident composite mental illness compared with those without HIV (aHR 1.63, 95% CI 1.44 to 1.85). PLWH vs those without HIV had significantly increased risks of developing each component of the composite score: depression (aHR 1.94; 95% CI 1.68 to 2.24), anxiety (aHR 1.38; 95% CI 1.15 to 1.66), and severe mental illness (aHR 2.18; 95% CI 1.41 to 3.39).
There is no clear explanation for the disparity in the risk of mental illness highlighted by the study. Adverse social implications of living with HIV such as stigma, discrimination, and lack of support may have a possible involvement in the development of mental illness. Additionally, factors such as comorbidities, recreational drug use, certain antiretrovirals, or a biological pathway related to chronic immune activation may also play a contributory role.
Regular Screening for Mental Illness Warranted
The authors stated: "Our results are not only important for the UK, but also for other high-income countries. Our findings support regular screening for mental illness in people living with HIV, and highlight the need to improve prevention and ensure all people living with HIV are being reached by existing screening programmes."
In an editorial accompanying the study, Dr Fiona C. Lampe from University College London, commented: "The results emphasise the need to prioritise the detection, management, and prevention of mental health conditions among people with HIV, including greater awareness of the risk, regular screening for depression, prompt treatment with evidence-based interventions, and appreciation of the socioeconomic context with links to appropriate support."
There was no funding source for the research. The authors and Dr Lampe report no competing interests.
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