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Prevalence of HIV Viral Load Suppression Among Psychiatric Inpatients with Comorbid Substance Use Disorders

Abstract

A consistently suppressed viral load enables HIV (+) patients to live longer, healthier lives and reduces the probability of transmitting the virus. Since the prevalence of HIV is four times higher among those with psychiatric disorders than in the general population, it is likely that this group would also have greater difficulty remaining in care and achieving viral suppression. A secondary data analysis utilizing screening data from the Preventing AIDS Through Health (PATH) for Triples (PFT) Study were examined to assess HIV load suppression among 254 psychiatric inpatients with comorbid substance use disorders in Philadelphia. Viral load results from the past 12 months were obtained from medical records for 63 inpatients identified as HIV (+). The sample was predominately African American (76%), male (56%), and the average age was 43 years. Psychiatric disorders included depression (64%), schizophrenia (21%), and bipolar disorder (13%) with patients reporting use of alcohol (73%), cocaine (64%), cannabis (29%) and opioids (16%) prior to admission. Among this high risk sample of HIV (+) patients, about one-half (52%) achieved viral suppression, with recent opioid users six times more likely to have a detectable viral load than non-opioid users (OR 6.0; CI 1.1–31.7, p = .035). The 52% viral load suppression rate among psychiatric inpatient was higher than expected, given that the CDC’s national suppression rate among those diagnosed with HIV in the general population is 58%. However, individuals with mental illness and substance use disorders require constant surveillance, monitoring, and supportive services to achieve viral suppression. Many of those who were virally suppressed were engaged in Philadelphia’s extensive treatment network, whereas those who were detectable and enrolled in the PFT intervention were often homeless with unstable psychiatric symptoms and current substance use disorders, particularly opioid abuse.

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Acknowledgements

This work was supported by the Penn Center for AIDS Research under Grant P30AI045008; the Penn Mental Health AIDS Research Center under Grant P30MH097488; and the PFT Intervention: Linking Triply-Diagnosed Inpatients to Community Care under Grant R01DA036503.

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Correspondence to D. M. Coviello.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the instructional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Coviello, D.M., Lovato, R., Apostol, K. et al. Prevalence of HIV Viral Load Suppression Among Psychiatric Inpatients with Comorbid Substance Use Disorders. Community Ment Health J 54, 1146–1153 (2018). https://doi.org/10.1007/s10597-018-0284-2

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Keywords

  • HIV
  • HIV viral load
  • Mental health
  • Psychiatric inpatients
  • Substance use disorders