With growing numbers of HIV-seropositive (HIV+) women of child-bearing age and increased access to effective clinical protocols for preventing mother-to-child transmission (MTCT) of HIV, mental health-related factors have become increasingly relevant due to their potential to affect the women’s quality of life, obstetric outcomes and risk of MTCT. This review synthesizes evidence from 53 peer-reviewed publications examining mental health-related variables in pregnant and postpartum HIV+ women. The presentation of results is organized by the level of socioeconomic resources in the countries where studies were conducted (i.e., high-, middle-, and low-income countries). It is concluded that psychiatric symptoms, particularly depression, and mental health vulnerabilities (e.g., inadequate coping skills) are widespread among pregnant HIV+ women globally and have a potential to affect psychological well-being, quality of life and salient clinical outcomes. The current body of evidence provides rationale for developing and evaluating clinical and structural interventions aimed at improving mental health outcomes and their clinical correlates in pregnant HIV+ women.

Introduction Post-traumatic stress disorder (PTSD) may be associated with chronic immune dysregulation and a pro-inflammatory state. Among HIV-infected individuals, PTSD is associated with greater morbidity and mortality, but the association with immune dysfunction has not been evaluated. This study explores the association between PTSD and selected markers of inflammation and immune activation in a cohort of HIV-infected, virally-suppressed individuals. Methods HIV-infected adults who were virologically controlled on anti-retroviral medications were recruited through a screening protocol for studies of HIV-related neurocognitive disorders. Each participant underwent blood draws, urine toxicology screen, and completed the Client Diagnostic Questionnaire (CDQ), a semi-structured psychiatric interview. Results Of 114 eligible volunteers; 72 (63%) were male, 77 (68%) African American, and 34 (30%) participants met criteria for PTSD. Participants with PTSD were more likely to be current smokers (79%) than those without (60%) (p=0.05). The PTSD cohort had significantly higher total white blood cell counts (5318 and 6404 cells/uL, p=0.03), absolute neutrophil count (2767 and 3577 cells/uL, p=0.02), CD8% (43 and 48, p=0.05) and memory CD8% (70 and 78%, p=0.04); lower naïve CD8% (30 and 22%, p=0.04), and higher rate of high-sensitivity C-reactive protein >3 mg/L (29 and 20, p=0.03). Discussion A high prevalence of PTSD was identified in this cohort of HIV-infected adults who were virally-suppressed. These results suggest that PTSD may be associated with immune dysregulation even among ART-adherent HIV-infected individuals.

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