HIV patients with mental health problems live just as long, says Australian study

HIV-positive individuals with mental health disorders survive just as long as HIV-positive people with good mental health, according to an Australian study published in the May edition of HIV Medicine. The investigators established, however, that patients with mental health problems took more antiretroviral drugs and spent more time in hospital than patients without mental health difficulties. Appropriate use of antiretroviral therapy could, they suggest, not only improve the health of patients with both HIV and mental health problems, but also reduce their use of healthcare resources.

Mental health disorders are common in people with HIV. Investigators from Melbourne, Australia, wished to determine the prevalence and impact of mental disorders in their clinic population between 1984 and 2000. They hypothesised that individuals with mental health problems would have a worse outcome, with poorer treatment outcome, reduced response to antiretroviral therapy, and increased mortality when compared to patients with no recorded mental health disorders.

The investigators performed a retrospective analysis including all 2,981 patients who received care for HIV at the Alfred Hospital. They cross-referenced this population with the VPCR database of mental health patients and found that 525 individuals matched.

Substance abuse was the most common psychiatric disorder seen in these individuals (17%), followed by affective disorders (9%) and personality disorders (2%). In 47% of cases, the cause of the mental health problem was unknown.

In a third of individuals, the mental health disorder pre-dated diagnosis with HIV. The investigators also observed that there were some slight differences in the demographics of patients recorded on the VPCR database and those of Alfred Hospital cohort. In particular, VPCR patients were less likely to be gay (58% versus 70%) and more likely to report injecting drug use as their HIV risk activity (24% versus 7%).

The investigators noted that 31% of individuals with mental health disorders received treatment with potent antiretroviral therapy after 1996 compared to 26% of individuals with no recorded mental health problems. They also noted that patients on the VPCR database used more antiretroviral drugs (median 6.4) than individuals with good mental health (median 5.5) and hypothesise that this was due to adherence problems or the capacity for some anti-HIV drugs, such as efavirenz (Sustiva) to exacerbate pre-existing mental health difficulties.

A third of individuals with mental health problems were hospitalised compared to 23% of patients with no recorded mental health disorders. The investigators also noted that there were differences in the reasons for hospitalisation between the two groups of patients, with patients with mental health problems more likely to be hospitalised because of infections (29% versus 20%), for non-infectious conditions such as liver problems (28% versus 19%) and for mental health reasons (18% versus 8%). Factors independently associated with an increased risk of hospitalisation were mental health problems (p < 0 .001), a prior AIDS-defining illness (p < 0.001) and receiving HIV treatment prior to 1986 (p = 0.001).

The investigators then looked to see if there was any relationship between a recorded mental health disorder and an increased risk of death. They found no difference in survival between patients in the general Alfred Hospital cohort and those on the VPCR database.

“Patients with psychiatric disorders are able to benefit from highly active antiretroviral therapy”, write the investigators. However, they note that their study was limited by its retrospective design. They conclude, “enhancing awareness and improving treatment in those with both HIV and mental health disorders may potentially improve quality of life for these patients but may also reduce unnecessary health care usage.”