The Prevalence of Mental Health Disorders in people with HIV and the effects on the HIV Care Continuum

Abstract

ABSTRACTObjectiveTo describe the prevalence of diagnosed depression, anxiety, bipolar disorder, and schizophrenia in people with HIV (PWH) and the differences in HIV care continuum outcomes in those with and without mental health disorders (MHD).DesignObservational study of participants in the NA-ACCORD.MethodsPWH (≥18 years) contributed data on prevalent schizophrenia, anxiety, depressive, and bipolar disorders from 2008-2018 based on ICD code mapping. MH multimorbidity was defined as having ≥ 2 MHD. Log binomial models with generalized estimating equations estimated adjusted prevalence ratios (aPR) and 95% confidence intervals for retention in care (≥ 1 visit/year) and viral suppression (HIV RNA ≤ 200 copies/mL) by presence vs. absence of each MHD between 2016-2018.ResultsAmong 122,896 PWH, 67,643 (55.1%) were diagnosed with ≥ 1 MHD: 39% with depressive disorders, 28% with anxiety disorders, 10% with bipolar disorder, and 5% with schizophrenia. The prevalence of depressive and anxiety disorders increased between 2008-2018, while bipolar disorder and schizophrenia remained stable. MH multimorbidity affected 24% of PWH. From 2016-2018 (N=64,684), retention in care was marginally lower among PWH with depression or anxiety, however those with MH multimorbidity were more likely to be retained in care. PWH with bipolar disorder had marginally lower prevalence of viral suppression (aPR=0.98 [0.98-0.99]) as did PWH with MH multimorbidity (aPR=0.99 [0.99-1.00]) compared with PWH without MHD.ConclusionThe prevalence of MHD among PWH was high, including MH multimorbidity. Although retention and viral suppression were similar to people without MHD, viral suppression was lower in those with bipolar disorder and MH multimorbidity.