Recognizing Cognitive and Psychiatric Changes in the Post‐Highly Active Antiretroviral Therapy Era

Abstract

Amid numerous complications that plague the health and quality of life of people living with HIV, neurocognitive and psychiatric illnesses pose unique challenges. While there remains uncertainty with respect to the pathophysiology surrounding these disorders, their adverse implications are increasingly recognized. Left undetected, they have the potential to significantly impact patient well being, adherence to antiretroviral treatment and overall health outcomes. As such, early identification of HIV-associated neurocognitive disorders (HAND) and psychiatric illnesses will be paramount in the proactive management of affected patients. The present review focuses on strategies to ensure optimal screening and detection of HAND, depression and substance abuse in routine practice. For each topic, currently available screening methods are discussed. These include identification of risk factors, recognition of relevant symptomatology and an update on validated screening tools that can be efficiently implemented in the clinical setting. Specifically addressed in the present review are the International HIV Dementia Scale, a novel screening equation and algorithm for HAND, as well as brief, validated, verbal questionnaires for detection of depression and substance abuse. Adequate understanding and usage of these screening mechanisms can ensure effective use of resources by distinguishing patients who require referral for more extensive diagnostic procedures from those who likely do not.

Knowledge of health practitioners regarding mental health integration into human immunodeficiency virus management into primary healthcare level

“…Additionally, mental health challenges may develop as adverse side effects of the use of antiretroviral therapy or from other socio-economic predicaments (Chuah et al 2017 ; Yi et al 2015 ). Although the use of antiretroviral drugs has tremendously changed HIV infection management, decreasing morbidity and mortality, there is still a need for effective follow-up by caregivers to achieve optimal results and also to ensure adherence to medication (Carvalhal et al 2012 ). Poor adherence to antiretroviral therapy is associated with psychiatric co-morbidities, and this lends support to a virologic as well as an immunologic failure (Carvalhal 2015 ).…”

Perception of Health Workers on the Integration of Mental Health Care with HIV Services in Primary Health Care Centres in Ogun East Senatorial District, Nigeria: A qualitative studyealth Services into HIV Care in Ogun East Senatorial District, Nigeria: A qualitative study

“…Moreover, mental illness is grossly under-diagnosed and undertreated among PLWHA. (Carvalhal et al, 2012) A multifaceted association exists between HIV and mental disorders. First, people with mental disorders may underutilize HIV and other medical care, leading to poor HIV treatment outcomes, which may further worsen the psychiatric condition.…”

Integrating Mental Health Care for People Living with HIV

“…For over a decade, research has shown that rates of mental health problems may be as high as 50% in people living with HIV (PHAs) [2]. Despite the high prevalence of mental illness, psychiatric disorders are commonly under-diagnosed and undertreated in this population [3].…”

“…HIV-positive individuals must also face the prospect of social stigma, long-term physical discomfort, illness and death [4]. Antiretroviral therapy has transformed the reality of HIV by reducing morbidity and mortality, but optimal results require close follow-up with providers and strict adherence to medication [3]. Psychiatric comorbidities are associated with poorer adherence to ART, leading to virologic and immunologic failure; co-morbidities may also impede the use of medical services and increase the physical and emotional demands on formal and informal caregivers [5].…”