HIV-infected patients with psychiatric disorders
experience inferior virologic responses to initial highly active
antiretroviral therapy (HAART), investigators report.
"Mental illness and substance abuse appear to affect how well
patients respond to HIV treatment," Dr. Brian Wells Pence from the
Center for Health Policy, Duke University, Durham, North Carolina told
Reuters Health. "Therefore, it is important to assess for and treat
comorbid psychiatric conditions in HIV patients."
Dr. Pence and associates examined the relationship between
psychiatric comorbidity and virologic and immunologic response among
198 patients initiating HAART. They report their findings in the
February 1st issue of the Journal of Acquired Immune Deficiency
Syndromes.
Patients with a higher predicted probability of having any mood,
anxiety, or substance use disorder were more likely to demonstrate
overall virologic failure and showed a trend toward delayed virologic
suppression after initiation of HAART, the authors report.
Patients with the highest predicted probability of having a
psychiatric or substance abuse disorder took about 41% longer to
achieve virologic suppression and developed virologic failure twice as
quickly as other patients, the results indicate.
The same trends were evident when depression, alcohol abuse or
dependence, and drug abuse or dependence were considered separately,
the researchers note.
"Although we hypothesize that reduced medication adherence may
explain part or all of the observed association between psychiatric
morbidity and clinical response to HAART, we were unable to test this
hypothesis in the current study," the investigators add.
Dr. Pence suggested that "patients should be screened at entry into care and at least yearly thereafter."
"We are planning a randomized, controlled trial to investigate
whether routine integration of depression screening and treatment into
HIV care improves HIV medication adherence and clinical outcomes," Dr.
Pence said.
J Acquir Immune Defic Syndr 2007;44:159-166.
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