This article was published on April 25, 2022. It was last updated/ edited on May 22, 2022.
1. Thanks to huge advances in antiretroviral therapy, people living with HIV now live almost all of their normal, expected lifespan. This means that their long-term physical and mental health concerns have become even more important.
Mental disorders/ symptoms and their consequences
2. Mental health symptoms are present in 30 to 60% of persons living with HIV (Hoare et al., 2021).
3. These patients are also at an increased risk of suicidal ideation, suicidal behavior, and completed suicide (Catalan et al., 2011).
4. A huge proportion (about two-thirds) of persons with HIV have pre-existing mental disorders.
5. Mental disorders, including depression, are associated in these patients with lower adherence to treatment and with the progression of HIV disease (Wagner et al., 2011; Repetto and Petitto, 2008).
Depression in people living with HIV
6. Depression is the commonest comorbidity in people living with HIV, with rates twice that in the general population (Wagner et al., 2011). It is one of the commonest reasons for people living with HIV (PLWH) to be evaluated by mental health clinicians. This depression in a person with HIV/ AIDS needs to be carefully evaluated because there are many possible reasons why the patient may be depressed. As noted above, many of these patients have pre-existing mental disorders.
7. Also, many antiretroviral medications (from different classes) can occasionally cause various psychiatric symptoms, including depression. So, we should be on the alert for the possibility that the depression could, in rare cases, be caused by an antiretroviral medication.
8. Opportunistic infections of the brain, which do occur in persons with HIV/ AIDS, can present with depressive symptoms (Ferrando et al., 1997).
Antidepressant treatment and its benefits
9. Unfortunately, clinically-significant depression frequently goes untreated in persons with HIV/ AIDS. In part, this seems to be because symptoms of depression are wrongly thought to be due to the HIV/ AIDS.
10. But, in one small study, antidepressant treatment of depressed patients with HIV led to improvement in depressive symptoms, both psychological and physical (Ferrando et al., 1997). One interesting observation in this study was that many of the physical symptoms that improved with antidepressant treatment had been attributed by the treatment team to HIV rather than to depression.
11. Meta-analyses of clinical trials have shown that antidepressants do work for clinical depression in patients with HIV (Eshun-Wilson et al., 2018; Hill and Lee, 2013).
12. Antidepressant treatment of clinically-significant depression in persons with HIV seems in many studies to not only reduce depression but also improve adherence to antiretroviral treatment (reviewed by El-Halabi et al., 2022).
Next, please see the following articles on this website:
Catalan J, Harding R, Sibley E, Clucas C, Croome N, Sherr L. HIV infection and mental health: suicidal behaviour–systematic review. Psychol Health Med. 2011 Oct;16(5):588-611. doi: 10.1080/13548506.2011.582125. Epub 2011 Jul 11. PMID: 21745024.
El-Halabi S, Cooper DH, Cha DS, Rosenblat JD, Gill B, Rodrigues NB, Lipsitz O, McIntyre RS, Gill H. The effects of antidepressant medications on antiretroviral treatment adherence in HIV-positive individuals with depression. J Affect Disord. 2022 Mar 1;300:219-225. doi: 10.1016/j.jad.2021.12.083. Epub 2021 Dec 22. PMID: 34952118.
Eshun-Wilson I, Siegfried N, Akena DH, Stein DJ, Obuku EA, Joska JA. Antidepressants for depression in adults with HIV infection. Cochrane Database Syst Rev. 2018 Jan 22;1(1):CD008525. doi: 10.1002/14651858.CD008525.pub3. PMID: 29355886; PMCID: PMC6491182.
Ferrando SJ, Goldman JD, Charness WE. Selective serotonin reuptake inhibitor treatment of depression in symptomatic HIV infection and AIDS. Improvements in affective and somatic symptoms. Gen Hosp Psychiatry. 1997 Mar;19(2):89-97. doi: 10.1016/s0163-8343(96)00172-7. PMID: 9097063.
Hoare J, Sevenoaks T, Mtukushe B, Williams T, Heany S, Phillips N. Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV. Curr HIV/AIDS Rep. 2021 Dec;18(6):569-580. doi: 10.1007/s11904-021-00583-w. Epub 2021 Nov 18. PMID: 34792706; PMCID: PMC8600343.
Hill L, Lee KC. Pharmacotherapy considerations in patients with HIV and psychiatric disorders: focus on antidepressants and antipsychotics. Ann Pharmacother. 2013 Jan;47(1):75-89. doi: 10.1345/aph.1R343. Epub 2013 Jan 22. PMID: 23341158.
Mills JC, Harman JS, Cook RL, Marlow NM, Harle CA, Duncan RP, Gaynes BN, Pence BW. Comparative effectiveness of dual vs. single-action antidepressants on HIV clinical outcomes in HIV-infected people with depression. AIDS. 2017 Nov 28;31(18):2515-2524. doi: 10.1097/QAD.0000000000001618. PMID: 28832409; PMCID: PMC5680130.
Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021 Dec 6;73(11):e3572-e3605. doi: 10.1093/cid/ciaa1391. Erratum in: Clin Infect Dis. 2021 Dec 08;: PMID: 33225349.
Wagner GJ, Goggin K, Remien RH, Rosen MI, Simoni J, Bangsberg DR, Liu H; MACH14 Investigators. A closer look at depression and its relationship to HIV antiretroviral adherence. Ann Behav Med. 2011 Dec;42(3):352-60. doi: 10.1007/s12160-011-9295-8. PMID: 21818528; PMCID: PMC3226751.
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