Mental, Neurological, and Substance Use Disorders in People Living With HIV/AIDS in Low- and Middle-Income Countries

Abstract

Depression, alcohol use disorders (AUD), and neurocognitive disorders are the 3 most prevalent mental, neurological, and substance use disorders in people living with HIV infection in low- and middle-income countries (LMICs). Importantly, they have an impact on everyday functions and on HIV outcomes. Many LMICs have validated tools to screen for and diagnose depression and AUD in the general population that can be used among people living with HIV infection. Current screening and diagnostic methods for HIV-associated neurocognitive disorders in the era of antiretroviral therapy are suboptimal and require further research. In our view, 2 research priorities are most critical. One is the development of an integrated screening approach for depression, AUD, and neurocognitive disorders that can be used by nonspecialists in LMICs. Second, research is needed on interventions for depression and AUD that also target behavior change, as these could impact on adherence to antiretroviral therapy and improve mental symptoms. Mentorship and fellowship schemes at an individual and institutional level need to be further supported to build capacity and provide platforms for research on HIV and mental, neurological, and substance use disorders in LMICs.

The Double Burdens of Mental Health Among AIDS Patients With Fully Successful Immune Restoration: A Cross-Sectional Study of Anxiety and Depression in China

“…A recent study of current depression among recently-diagnosed men who have sex with men (MSM) found 36% prevalence of depression, (26) in line with our finding of 34% depression prevalence among recently-diagnosed patients. People who inject drugs had the highest prevalence of depression and anxiety, in line with a rich literature documenting the comorbidities of mental health and substance use (4, 27, 28). …”

Efeito do álcool em pessoas com HIV: tratamento e qualidade de vida

“…(19,20) In addition, some patients stop taking the medicines to drink alcoholic beverages on weekends; (23) consequently, they do not reach complete viral suppression and are more susceptible to viral resistance. (24) In general, alcohol use is a strong predictor of drug adherence failures, and worsens the clinical outcome of PLWHA. (2,16,25) The consumption of alcohol and other substances that cause dependence in PLWHA can trigger competition and interactions with antiretrovirals, and change their binding protein, because ethanol competes with the drugs in the isoenzyme linkages of the metabolization process.…”

Quinolinic acid/tryptophan ratios predict neurological disease in SIV-infected macaques and remain elevated in the brain under cART

“…These neurological disorders afflict a substantial proportion of HIV-infected individuals, with estimates ranging from 20–60% despite access to cART (Robertson et al 2007; Heaton et al 2010; Chibanda et al 2014; Ances and Ellis 2007). Furthermore, cognitive impairment and depression are risk factors for each other, decrease cART compliance, and are associated with a faster progression to AIDS and mortality (Chibanda et al 2014; Del Guerra et al 2013). Enhanced catabolism of tryptophan (TRP) through the kynurenine pathway (KP) may contribute to the etiology of both of these disorders by generating neurotoxic levels of KP metabolites and diverting TRP away from serotonin synthesis, though evidence in brain tissue has remained limited.…”