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HIV and Mental Health

CE / CME

Re:Mind—Making Mental Health Care an Integral Part of HIV Care

Nurses: 0.75 Nursing contact hour

Pharmacists: 0.75 contact hour (0.075 CEUs)

Physicians: maximum of 0.75 AMA PRA Category 1 Credit™

Released: July 23, 2024

Expiration: July 22, 2025

Glenn J. Treisman
Glenn J. Treisman, MD, PhD
CME/CE Information

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HIV Infection and Mental Health Conditions1-4

The prevalence of mental health conditions in people living with HIV is higher than in the general population. Up to 54% of people living with HIV are diagnosed with a mental health condition or substance use disorder (Axis I disorder).3

Mental health conditions that are prevalent in people living with HIV include major depression and generalized anxiety disorder.

Chronic, debilitating mental illnesses such as schizophrenia and schizophrenia-like disorders are less prevalent, but are an important population because presence of such mental illnesses is a risk factor for acquiring HIV. HIV infection rates occur more often in people with chronic, debilitating mental illnesses than in the general population (6% vs 0.4%).1

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Impact of Mental Health Conditions on HIV Risk and Outcomes5-7

People with mental health conditions are MORE likely than the general population to:

  • Acquire HIV infection
  • Experience premature mortality

Whereas people with mental health conditions are LESS likely than the general population to:

  • Receive and persist on antiretroviral therapy (ART)
  • Achieve an undetectable HIV-1 RNA level
  • Remain in HIV care

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Interplay Between Mental Health Conditions and HIV8,9

The presence of mental health conditions increases the risk for acquisition of HIV because people are depressed, can become impulsive, experience hopelessness, and feel overwhelmed. These effects on their mental well-being can lead them to choose behaviors that put them at risk of acquiring HIV.

People can have addiction to sex or to drugs and those addictive behaviors may lead to high-risk behaviors.

Once people acquire HIV, chronic inflammation from the infection, demoralizing stigma associated with the condition, and medications to treat HIV can all complicate mental health conditions. In the setting of HIV, depression and other mental health conditions can worsen.

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A Web of Comorbidities5,9,10

HIV infection and treatment for it can cause adverse events such as nerve tissue injury and immune dysregulation.

These, in turn, can cause neurologic and psychiatric complications that then lead to disability and dysfunctional behaviors. Things like risky behavior and poor medication adherence can feed back to worsen the neurologic and psychiatric complications associated with living with HIV.

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Mental Health Conditions and Stigma11

Stigma is common in people living with mental health conditions and in people living with HIV. Its impact can be compounded in people living with both conditions. Often, people prefer to link their symptoms to other things rather than admit to themselves that they have depression.

Self-stigma negatively affects self-esteem and hopefulness and can lead to a number of negative outcomes.

Mental health conditions are diseases, just like diabetes or hypertension, and we need healthcare professionals (HCPs) and patients to think of them this way. In fact, that might be the most important message I hope you come away with: Mental health conditions are treatable and can be managed by nonpsychiatric HCPs.

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