mental health AIDS

Summer 2007 Newsletter / Volume 8, Issue 4

HIV Treatment News

Medical Care

Pence, Miller, Gaynes, and Eron (2007) examined the relationship between psychiatric comorbidity and immunologic/virologic response among 198 antiretroviral-naïve men and women receiving care in an academic medical center in the southeastern U.S.

Probabilities [of having (1) any mood, anxiety, or substance use disorder; (2) clinically relevant depression; (3) alcohol abuse/dependence; and (4) drug abuse/dependence] were based on responses to questions on a ... screening instrument (Substance Abuse and Mental Illness Symptoms Screener [SAMISS]) and other clinical and sociodemographic characteristics and were derived using predictive logistic regression modeling from a separate validation study of the SAMISS compared with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition[,] diagnoses. (p. 159)

Pence and colleagues

found an association between patients' predicted risk of having a mood, anxiety, or substance use diagnosis and virologic response to HAART [highly active antiretroviral therapy]. Patients initiating HAART who had a higher predicted probability of psychiatric morbidity took longer, on average, to achieve virologic suppression and were quicker to demonstrate overall virologic failure. Associations between risk of psychiatric morbidity and time to virologic rebound and immunologic failure were consistent in direction, although not statistically significant. Predicted probabilities separately predicting presence of diagnoses of depression, alcohol abuse, and [substance abuse] demonstrated similar relations. (p. 163)

Although the investigators hypothesized "that reduced medication adherence may explain part or all of the observed association between psychiatric morbidity and clinical response to HAART, ... [they] were unable to test this hypothesis in the current study" (p. 164). Regardless of mechanisms operating to reduce virologic response, however, Pence and colleagues contend that "[t]hese findings argue for the importance of identifying and treating comorbid psychiatric illness in patients initiating HAART to optimize their HIV clinical outcome" (p. 165).

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