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The HIV epidemic among individuals with mental illness in the United States

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Abstract

People with depression and other mental illness comprise a growing proportion of individuals living with HIV in the United States; at the same time, the prevalence of HIV among mentally ill individuals is at least seven times higher than in the general population. Individuals with mental illness are particularly vulnerable to infection with HIV because of several factors, including the higher prevalence of poverty, homelessness, high-risk sexual activities, drug abuse, sexual abuse, and social marginalization found in this population. Nevertheless, mentally ill individuals are often not screened for HIV and may not be appropriately targeted in current HIV prevention efforts. Moreover, despite widespread access to antiretroviral treatment in the United States, HIV outcomes among mentally ill individuals continue to be poor. This disparity can be explained by several interrelated factors, including lower rates of highly active antiretroviral therapy (HAART) utilization, lower rates of adherence to HAART, and immunologic changes associated with mental illness itself. We need to improve our design of prevention, screening, and treatment programs to better reach individuals with comorbid HIV and mental illness.

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References and Recommended Reading

  1. Palella FJ Jr, Delaney KM, Moorman AC, et al.: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study (HOPS) Investigators. N Engl J Med 1998, 19:182–188.

    Google Scholar 

  2. Bing EG, Burnam MA, Longshore D, et al.: Psychiatric disorders and drug use among HIV-infected adults in the US. Arch Gen Psychiatry 2001, 58:721–728.

    Article  PubMed  CAS  Google Scholar 

  3. Cook J, Cohen MH, Grey D, et al.: Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV-seropositive women. J Acquir Immune Defic Syndr 2002, 30:401–409. This prospective, multicenter study found a very high prevalence of depression (73%) among HIV-positive women; depressive symptoms were predictive of lower HAART utilization.

    PubMed  Google Scholar 

  4. Rosenberg SD, Goodman LA, Osher FC, et al.: Prevalence of HIV, hepatitis B and hepatitis C in people with severe mental illness. Am J Public Health 2001, 19:31–37.

    Google Scholar 

  5. Stewart DL, Zuckerman CJ, Ingle JM: HIV seroprevalence in a chronically mentally ill population. J Natl Med Assoc 1994, 86:519–523.

    PubMed  CAS  Google Scholar 

  6. Cournos F, McKinnon K: HIV seroprevalence among people with severe mental illness in the United States: a critical review. Clin Psychol Rev 1997, 17:259–269.

    Article  PubMed  CAS  Google Scholar 

  7. Grassi L: Risk of HIV infection in psychiatrically ill patients. AIDS Care 1996, 8:103–116.

    Article  PubMed  CAS  Google Scholar 

  8. Silberstein C, Galanter M, Marmor M, et al.: HIV-1 among inner city dually diagnosed inpatients. Am J Drug Alcohol Abuse 1994, 20:201–213.

    Google Scholar 

  9. Sacks MH, Dermatis H, Looser-Ott S, et al.: Undetected HIV infection among acutely ill psychiatric inpatients. Am J Psychiatry 1992, 43:736–737.

    CAS  Google Scholar 

  10. Sullivan G, Koegel P, Kanouse D, et al.: HIV and people with serious mental illness: the public sector’s role in reducing HIV risk and improving care. Psychiatric Serv 1999, 50:648–652.

    CAS  Google Scholar 

  11. Kilbourne AM, Justice AC, Rollman BL, et al.: Clinical importance of HIV and depressive symptoms among veterans with HIV infection. J Gen Intern Med 2002, 17:512–520.

    Article  PubMed  Google Scholar 

  12. Williams JB, Rabkin JG, Remien RH, et al.: Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. II. Standardized clinical assessment of current and lifetime psychopathology. Arch Gen Psychiatry 1991, 48:124–130.

    PubMed  CAS  Google Scholar 

  13. Turner BJ, Fleishman JA, Wenger N, et al.: Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons. J Gen Intern Med 2001, 16:625–633.

    Article  PubMed  CAS  Google Scholar 

  14. James ME, Rubin CP, Willis SE: Drug abuse and psychiatric findings in HIV-seropositive pregnant patients. Gen Hosp Psychiatry 1991, 13:4–8.

    Article  PubMed  CAS  Google Scholar 

  15. Rosenberger P, Bornstein R, Nasrallah H: Psychopathology in human immunovirus infection: lifetime and current assessment. Compr Psychiatry 1993, 34:150–158.

    Article  PubMed  CAS  Google Scholar 

  16. Sewell D: Schizophrenia and HIV. Schizophr Bull 1996, 22:465–473.

    PubMed  CAS  Google Scholar 

  17. Carey MP, Carey KB, Kalichman SC: Risk for human immunodeficiency virus (HIV) infection among persons with severe mental illness. Clin Psychol Rev 1997, 17:271–291.

    Article  PubMed  CAS  Google Scholar 

  18. Susser E, Valencia E, Miller M, et al.: Sexual behavior of homeless mentally ill men at risk for HIV. Am J Psychiatry 1995, 152:583–587.

    PubMed  CAS  Google Scholar 

  19. Volavka J, Convit A, O’Donell J, et al.: Assessment of risk behaviors for HIV infection among psychiatric inpatients. Hosp Community Psychiatry 1992, 43:482–485.

    PubMed  CAS  Google Scholar 

  20. Fairfield KM, Libman H, Davis RB, et al.: Delays in protease inhibitor use in clinical practice. J Gen Intern Med 1999, 14:446–448.

    Article  Google Scholar 

  21. Bassetti S, Battegay M, Furrer H, et al.: Why is highly active antiretroviral therapy (HAART) not prescribed or discontinued? J Acquir Immune Defic Syndr 1999, 21:114–119.

    PubMed  CAS  Google Scholar 

  22. Pulvirenti J, Glowacki R, Muppiddi U, et al.: Hospitalized HIVinfected patients in the HAART era: a view from the inner city. AIDS Patient Care STDS 2003, 17:565–573.

    Article  PubMed  Google Scholar 

  23. Mocroft A, Madge S, Johnson A, et al.: A comparison of exposure groups in the EuroSIDA study: starting highly active antiretroviral therapy (HAART), response to HAART and survival. J Acquir Immune Defic Syndr 1999, 22:369–378.

    PubMed  CAS  Google Scholar 

  24. Kalichman S, Graham J, Luke W, Austin J: Perceptions of healthcare among persons living with HIV/AIDS who are not receiving antiretroviral medications. AIDS Patient Care STDS 2002, 16:233–240.

    Article  PubMed  Google Scholar 

  25. Maisels L, Steinberg J, Tobias C: An investigation of why eligible patients do not receive HAART. AIDS Patient Care STDS 2001, 15:185–191.

    Article  PubMed  CAS  Google Scholar 

  26. Wood E, Montaner J, Bangsberg D, et al.: Expanding access to HIV antiretroviral therapy among marginalized populations in the developed world. AIDS 2003, 17:2419–2427.

    Article  PubMed  Google Scholar 

  27. Bogart LM, Kelly JA, Catz SL, et al.: Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment. J Acquir Immune Defic Syndr 2000, 23:396–404.

    PubMed  CAS  Google Scholar 

  28. Kiley DJ, Lam CS, Pollak R: A study of treatment compliance following kidney transplantation. Transplantation 1993, 55:51–56.

    Article  PubMed  CAS  Google Scholar 

  29. Bosley CM, Fosbury JA, Cochrane GM: The psychological factors associated with poor compliance with treatment in asthma. Eur Respir J 1995, 8:899–904.

    PubMed  CAS  Google Scholar 

  30. Lebovits AH, Strain JJ, Schleifer SJ, et al.: Patient noncompliance with self-administered chemotherapy. Cancer 1990, 65:17–22.

    Article  PubMed  CAS  Google Scholar 

  31. Taal E, Seydel ER, Basker JJ, et al.: Psychosocial aspects of rheumatic diseases: introduction. Patient Educ Couns 1993, 20:55–61.

    Article  PubMed  CAS  Google Scholar 

  32. Starace F, Ammassari A, Trotta MP, et al.: Depression is a risk factor for suboptimal adherence to antiretroviral therapy. J Acquir Immune Defic Syndr 2002, 31:S136-S139.

    PubMed  Google Scholar 

  33. Singh N, Squier C, Sivek C, et al.: Determinants of compliance with antiretroviral therapy in patients with immunodeficiency virus: prospective assessment with implications for enhancing compliance. AIDS Care 1996, 8:261–268.

    Article  PubMed  CAS  Google Scholar 

  34. Holzemer WL, Corless IB, Nokes KM, et al.: Predictors of selfreported adherence in persons living with HIV disease. AIDS Patient Care STDS 1999, 13:185–197.

    Article  PubMed  CAS  Google Scholar 

  35. Paterson DL, Swindells S, Mohr J, et al.: Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med 2000, 13:1763–1769.

    Google Scholar 

  36. Cordillo V, Del Amo J, Soriano V, et al.: Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS 1999, 13:1763–1769.

    Article  Google Scholar 

  37. Tucker JS, Burnam A, Shelbourne CD, et al.: Substance use and mental health correlates of non-adherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. Am J Med 2003, 114:573–580. This study found that patients with a psychiatric disorder or active substance abuse were significantly more likely to report poor adherence to antiretroviral therapy.

    Article  PubMed  Google Scholar 

  38. Bangsberg DR, Perry S, Charlebois ED, et al.: Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS 2001, 15:1181–1183.

    Article  PubMed  CAS  Google Scholar 

  39. Hogg RS, Heath K, Bangsberg D, et al.: Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up. AIDS 2002, 16:1051–1058.

    Article  PubMed  Google Scholar 

  40. DeOlalla P, Knobel H, Carmona A, et al.: Impact of adherence on highly active antiretroviral therapy on survival in HIV-infected patients. J Acquir Immune Defic Syndr 2001, 30:105–110.

    Google Scholar 

  41. Stephenson J: AIDS researchers target poor adherence. JAMA 1999, 281:1069.

    Article  PubMed  CAS  Google Scholar 

  42. Weiser S, Wolfe W, Bangsberg D, et al.: Barriers to antiretroviral adherence for patients living with HIV and AIDS in Botswana. J Acquir Immune Defic Syndr 2003, 34:281–288.

    Article  PubMed  Google Scholar 

  43. Burack JH, Barrett DC, Stall RD, et al.: Depressive symptoms and CD4 lymphocyte decline among HIV-infected men. JAMA 1993, 270:2568–2573.

    Article  PubMed  CAS  Google Scholar 

  44. Cruess DG, Douglas SD, Petitto JM, et al.: Association of depression, CD8+ T lymphocytes and natural killer cell activity: implications for morbidity and mortality in human immunodeficiency virus disease. Curr Psychiatry Rep 2003, 5:445–450.

    Article  PubMed  Google Scholar 

  45. Evans DL, Douglas SD, Gettes DR, et al.: Association of depression with viral load, CD8 T lymphocytes, and natural killer cells in women with HIV infection. Am J Psychiatry 2002, 10:1752–1759. This longitudinal cohort study of HIV-positive women found that depression was associated with a higher viral load and higher activated CD8 T lymphocytes; these findings suggest a mechanism for the relationship between depression and rapid HIV disease progression.

    Article  Google Scholar 

  46. Ickovics JR, Hamburger ME, Vlahov D, et al.: Mortality, CD4 count decline and depressive symptoms among HIV-seropositive women. Longitudinal analysis from the HIV Epidemiology Research Study. JAMA 2001, 285:1466–1474. This prospective cohort study of 765 women with HIV found that depression was significantly associated with more rapid disease progression and higher mortality when controlling for sociodemographic and clinical characteristics.

    Article  PubMed  CAS  Google Scholar 

  47. Mayne TJ, Vittinghoff E, Chesney MA, et al.: Depressive affect and survival among gay and bisexual men infected with HIV. Arch Intern Med 1996, 156:2233–2238.

    Article  PubMed  CAS  Google Scholar 

  48. Page-Shafer K, Delorenze GN, Satariano W, et al.: Comorbidity and survival in HIV-infected men in the San Francisco Men’s Health Survey. Ann Epidemiol 1996, 6:420–430.

    Article  PubMed  CAS  Google Scholar 

  49. Leserman J, Jackson ED, Petitto JM, et al.: Progression to AIDS: the effects of stress, depressive symptoms, and social support. Psychosom Med 1999, 61:397–406.

    PubMed  CAS  Google Scholar 

  50. Leserman J, Petitto JM, Gu H, et al.: Progression to AIDS, a clinical AIDS condition and mortality: psychosocial and physiological predictors. Psychol Med 2002, 32:1059–1073.

    Article  PubMed  CAS  Google Scholar 

  51. Folkman S, Chesney M, Pollack L, Coates T: Stress, control, coping, and depressive mood in human immunodeficiency virus-positive and -negative gay men in San Francisco. J Nerv Ment Dis 1993, 181:409–416.

    Article  PubMed  CAS  Google Scholar 

  52. Antoni MH, Cruess DG, Klimas N, et al.: Stress management and immune system reconstitution in symptomatic HIVinfected gay men over time: effects on transitional naive T cells (CD4(+)CD45RA(+)CD29(+)). Am J Psychiatry 2002, 159:143–145.

    Article  PubMed  Google Scholar 

  53. Antoni MH: Stress management effects on psychological, endocrinological, and immune functioning in men with HIV infection: empirical support for a psychoneuroimmunological model. Stress 2003, 6:173–188.

    Article  PubMed  CAS  Google Scholar 

  54. Antoni MH: Stress management and psychoneuroimmunology in HIV infection. CNS Spectr 2003, 8:40–51.

    PubMed  Google Scholar 

  55. Katz MH, Douglas JM, Bolan GA, et al.: Depression and use of mental health services among HIV-infected men. AIDS Care 1996, 8:433–442.

    Article  PubMed  CAS  Google Scholar 

  56. Sambamoorthi U, Walkup J, Olfson M, et al.: Antidepressant treatment and health services utilization among HIV-infected Medicaid patients diagnosed with depression. J Gen Intern Med 2000, 15:311–320.

    Article  PubMed  CAS  Google Scholar 

  57. Turner BJ, Laine C, Cosler L, et al.: Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users. J Gen Intern Med 2003, 18:248–257.

    Article  PubMed  Google Scholar 

  58. Chan KS, Orlando M, Joyce G, et al.: Combination antiretroviral therapy and improvements in mental health: results from a national representative sample of persons undergoing care in the United States. J Acquir Immune Defic Syndr 2003, 33:104–111.

    PubMed  Google Scholar 

  59. Babudieri S, Aceti A, D’Offizi GP, et al.: Directly observed therapy to treat HIV infection in prisoners. JAMA 2000, 284:179–180.

    Article  PubMed  CAS  Google Scholar 

  60. Farmer P, Leandre F, Mukherjee J, et al.: Community-based approaches to HIV treatment in resource-poor settings. Lancet 2001, 358:404–409.

    Article  PubMed  CAS  Google Scholar 

  61. Mitty JA, Mckenzie M, Stenzel M, et al.: Modified directly observed therapy for treatment of human immunodeficiency virus. JAMA 1999, 282:1334.

    Article  PubMed  CAS  Google Scholar 

  62. Khanlou H, Kandalu VR, Stein TG: Pilot study of directly observed therapy in highly non-adherent HIV-infected patients in an urban community-based institution. J Acquir Immune Defic Syndr 2003, 33:651–653.

    Article  PubMed  Google Scholar 

  63. Angelino AF, Treisman GJ: Management of psychiatric disorders in patients infected with human immunodeficiency virus. Clin Infect Dis 2001, 33:847–855.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Epidemiology and Prevention Interventions Center, San Francisco General Hospital, 94143, San Francisco, CA, USA

    Sheri D. Weiser MD, MPH

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  1. Sheri D. Weiser MD, MPH
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  2. William R. Wolfe MD
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  3. David R. Bangsberg MD, MPH
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Weiser, S.D., Wolfe, W.R. & Bangsberg, D.R. The HIV epidemic among individuals with mental illness in the United States. Curr HIV/AIDS Rep 1, 186–192 (2004). https://doi.org/10.1007/s11904-004-0029-4

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