Does Diagnosis Make a Difference? Estimating the Impact of an HIV Medication Adherence Intervention for Persons with Serious Mental Illness

Abstract

The heightened risk of persons with serious mental illness to contract and transmit human immunodeficiency virus (HIV) is a public health problem. Here we evaluate the interaction between psychiatric diagnosis and response to a community based-intervention targeted at treatment adherence in 236 HIV+ persons with co-occurring mental illness. To examine differential effectiveness of the intervention for categories of patient diagnosis, we reanalyzed the data after stratifying participants into two diagnostic groups: (1) participants with depressive disorders without psychosis and (2) participants with a psychotic or bipolar disorder. Outcomes included viral load and mental health quality of life (SF-12 Mental Health). We found that HIV+ persons with non-psychotic depressive disorders demonstrated a larger decrease in HIV viral load and more improvement in measures of mental health quality of life when compared to HIV+ persons with psychotic and bipolar disorders. We suggest that successful adherence interventions should be informed by psychiatric symptomatology.

The Characteristics and HIV-Related Outcomes of People Living with Co-occurring HIV and Mental Health Conditions in the United States: A Systematic Review of Literature from 2016 to 2021

“…Further, SMI negatively affects HIV treatment outcomes. Five studies looked at HIV treatment and/or health outcomes among PLWH and co-occurring SMI, with four looking at behavioral health associations with HIV treatment adherence and/or VLS [ 2 , 3 , 9 , 43 ], and one evaluating ART prescription patterns [ 44 ]. Two of these studies focused on PLWH who were receiving inpatient mental health treatment [ 9 , 44 ].…”

“…An evaluation of ART prescription patterns for 506 PLWH receiving care within psychiatric inpatient settings indicated that ART was prescribed upon discharge for 39% of the study population, starting at 28% the first year and was generally increasing over time (χ2 6 = 14.05; P = 0.03) [ 44 ]. Findings from community-based treatment adherence interventions showed that PLWH with co-occurring psychotic and bipolar disorders had worse VLS compared to those with co-occurring non-psychotic depressive disorders [ 43 ].…”

“…Findings are less consistent regarding SMI and other psychiatric conditions. A qualitative study showed PLWH with non-psychotic depressive disorders had better VLS than those with psychotic and bipolar disorders [ 43 ]. Whereas a study on PLWH receiving inpatient psychiatric care found no association between psychiatric disorders and VLS [ 9 ].…”

Anais Do 2° Congresso Internacional Multiprofissional Em Atenção Primária À Saúde

“…Quanto aos principais fatores que contribuem para o alto risco de ISTs em pacientes com TAB, a literatura analisada destaca os episódios maníacos, pois, neles, o paciente encontrase hiperssexualizado e tem sentimentos de invulnerabilidade que podem trazer a ideia de que é imune a doenças (DINC et al, 2019;SAHOTA et al, 2020). Além disso, tais episódios podem ser acompanhados de delírios de grandeza e persecutórios, que podem, respectivamente, levar o paciente a crer que tem maior conhecimento do que os profissionais que procuram oferecerlhe cuidado e causar a desconfiança do paciente em profissionais de saúde e medicamentos (DALSETH et al, 2018).…”

“…A forte associação entre TAB e ISTs também pode ser analisada sob o aspecto da dificuldade de supressão da carga viral. 2 dos artigos analisados evidenciam que, em meio a PVHIV, a bipolaridade, quando comparada ao transtorno depressivo maior, representa maior risco para a não supressão da carga viral (LEVY et al, 2019;DALSETH et al, 2018). Isso está diretamente relacionado aos episódios depressivos bipolares, nos quais o paciente enfrenta desânimo, falta de entusiasmo com o futuro e desvelo consigo próprio, o que inclui a descontinuação do tratamento antirretroviral (DALSETH et al, 2018).…”