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With data obtained from a departmental electronic medical record system, Baillargeon et al. (2008) "examined the association of six major psychiatric disorders with HIV mono-infection, HIV/HCV [(hepatitis C virus)] co-infection and HIV/HBV [(hepatitis B virus)] co-infection ... [among] 370,511 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January 1, 2003 and July 1, 2006" (p. 124). The six psychiatric disorders under study included major depressive disorder, dysthymic disorder, bipolar disorder, schizophrenia, schizoaffective disorder, and psychotic disorders other than schizophrenia. Baillargeon and colleagues found that "all four disease groups (all HIV combined, HIV only, HIV/HCV and HIV/HBV) exhibited consistently higher rates of psychiatric disorders than their uninfected counterparts. With the exception of two outcomes (schizophrenia and schizoaffective disorder) in the HIV/HBV group, these associations persisted across all of the disorders under study and were statistically significant even after adjusting for age, gender and race" (p. 127). Additionally, in "comparison to offenders with HIV mono-infection, those with HIV/HCV co-infection had an elevated prevalence of any psychiatric disorder" (p. 124). These "findings suggest that HIV-infected offenders, particularly those co-infected with HCV, may benefit from targeted interventions that integrate mental health, prevention and pharmacotherapy adherence programs" (p. 128).
Similarly, Tegger et al. (2008) monitored a cohort of men and women living with HIV and receiving care at a university-affiliated HIV primary care clinic in Seattle, Washington, since 1995. In a review of data from 2004, Tegger and colleagues found that, among 1,774 cohort participants,
63% had a mental illness (including mood, anxiety, psychotic, or personality disorders), 45% had a substance use disorder, and 38% had both. There were 278 patients who met criteria for HAART [(highly active antiretroviral therapy)] eligibility. After controlling for other factors, patients with depression and/or anxiety were significantly less likely to initiate HAART compared with patients without a mental illness ... . However, patients with depression/anxiety who received antidepressant/antianxiety medications were equally likely to initiate HAART as patients without a mental illness ... . [The investigators] found that patients with mental illness or substance use disorders receive HAART at lower CD4+ cell counts and higher HIV-1 RNA [(viral load)] levels than patients without these disorders. However, HAART initiation among patients who receive treatment for depression/anxiety is associated with no delay. (p. 233)
These "findings suggest a need for mental illness and substance use screening in HIV-primary care settings that do not already do so, as well as integrated psychiatric care and substance use treatment" (p. 240).
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Summer 2008 Newsletter / Volume 9, Issue 4
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