A study by Tiffany Gooden and colleagues at Lancet HIV It shows how people living with HIV in the UK are more likely to develop mental illness than people without HIV. During the study, people with HIV were 63% more likely to develop a mental illness, compared to people without HIV.
It has been well documented that the prevalence of mental illness (including depression, anxiety, and severe mental illness) is higher among people living with HIV. However, this is probably the first study to report new cases of these conditions in people with HIV, using a congruent, population-based, cohort approach, thus providing better evidence of the disproportionate impact of mental illness on people living with people living with HIV. HIV compared to people without HIV. .
The study was conducted between 2000 and 2020 using data from a large UK primary care database to compare new mental illness in 7,167 people with HIV and a control group of people without HIV, who had not been diagnosed with mental illness.
The matching process for both groups was based on region, age, gender, ethnicity, deprivation, smoking status, body mass index, substance use, cardiovascular disease, hypertension, and diabetes. The researchers also looked at these variables to draw conclusions about how the risk of mental illness varies in different groups of people with HIV.
Their findings show that 586 people with HIV developed mental illness, compared with 418 people without HIV in the 20 years of the study (incidence rates of 19.6 and 12.1 per 1,000 person-years, respectively). This means that for every 1,000 HIV-positive people who are followed for a year, 19 people are expected to develop a mental illness.
More specifically, they found a higher incidence of depression, anxiety, and severe mental illness (such as psychosis, schizophrenia, and bipolar disorder) in people with HIV compared to people without HIV. 495 HIV-positive people developed depression, 266 anxiety, and 64 severe mental illness, compared to 298, 214, and 30, respectively, in non-HIV subjects.
Risks changed significantly with gender, showing that men with HIV had twice the risk of developing mental illness compared to those without, while women showed no differences between the two groups.
The risk of mental illness was elevated for those living with HIV regardless of age, deprivation, and smoking status, and the risk did not decrease during the 20 years of the study.
People with HIV who were white, non-obese or who did not use drugs or drink heavily, were more likely to develop mental illness while those who were from ethnic minorities, obese, or who abused substances did not.
Severe mental illnesses (eg psychosis, schizophrenia, bipolar disorder) were reported to be higher among those living with HIV in the most disadvantaged groups and those diagnosed in the early stages of the study (2000–2009).
However, this study has some limitations. It was made at a time (2003-2015) when efavirenz was commonly prescribed, and its side effects (including mood disorders) may have been recorded as mental health conditions.
In addition, their data set did not include mode of transmission and sexual orientation, and the prevalence of HIV detected (0.11%) is lower than national estimates (0.15%) due to people not sharing their condition with their GP.
These limitations mean that more studies are needed to investigate the increased risk of mental illness in people living with HIV. It also increases the importance of understanding the biological mechanisms and psychosocial factors (including stigma) that act as drivers and barriers to screening and diagnosis of mental illness.
The higher rates of mental illness diagnoses among the HIV-positive people in the study could be due to increased contact with healthcare professionals, persistent immune activation caused by HIV infection, stigma and discrimination, and existing socioeconomic disparities.
HIV and mental health go hand in hand, and poor mental health can be both a risk factor and a potential consequence of HIV. It is among the most common comorbidities experienced by people with HIV. The personal and public health crisis affects well-being and quality of life, exacerbates existing inequalities and can lead to disruption of treatment, which may lead to further transmission of HIV.
The results of this study are relevant not only in the UK but in other high-income countries as well. People living with HIV are more likely to be diagnosed with depression, anxiety, and severe mental illness than those without HIV.
Therefore, people living with HIV should continue to be regularly screened for symptoms of mental illness, reached through effective interventions that prevent and manage mental illness, and targeted through outreach programs that ensure that key communities are not underdiagnosed. .