Adolescents with Perinatally-Acquired HIV Are Not at Increased Risk of Anxiety, Depression

MARCH 22, 2018
Elizabeth Kukielka, PharmD
Marthe Le Prevost, a senior research nurse at the University College LondonMarthe Le Prevost, Senior Research Nurse
Adolescents and Adults Living with Perinatal HIV (AALPHI) is an ongoing study in the United Kingdom that follows a cohort of young people with perinatally-acquired HIV (PHIV) and a control group of HIV-affected youth, who have a parent, sibling, or other household member living with HIV. The study was designed to examine the effect of lifelong-HIV infection and long-term antiretroviral therapy (ART) on neurocognitive function, cardiac function, metabolic function, sexual and reproductive health, and growth and body composition.

Marthe Le Prevost, a senior research nurse at the University College London who coordinates the study, and colleagues recently published an article examining the incidence of anxiety and depression among young people with PHIV. This is the first study of its kind of moderate size and scope in the UK or Europe.

“Young people with perinatal HIV (PHIV) may be at increased risk of anxiety and depression compared to other adolescents because of a complex mix of psycho-social issues and biomedical factors that are associated with chronic illness," Le Prevost and colleagues said explaining the basis of their study.

The study group consisted of 283 patients with PHIV, ages 13–21, while the control group consisted of 96 patients ages 13–23 who were HIV-negative but in close contact (household member or close friend) with someone who was HIV-positive. Participants had to be living the United Kingdom for at least 6 months and able to speak English. Both groups underwent a 2-hour face-to-face interview along with a computer-assisted survey for sensitive questions.

For the study group, additional HIV-related factors that could impact mental health were also considered, including: age diagnosed with HIV, age starting ART and current ART status, current efavirenz use (due to potential association with depression), nadir and most recent CD4 cell count, most recent viral load ≤50 copies/mL vs. >50 copies/ mL, median cumulative years with viral load <400 copies/mL, HIV disclosure factors (age told HIV status and ever told anyone HIV status) and current feeling about HIV status.

Among both the study group and the control group, the majority (two-thirds) of patients were black females born outside of the UK, typically in sub-Saharan Africa.

Contrary to expectation, overall anxiety and depression scores were similar in both the study group and the control group, both before and after adjusting for other factors. Scores of anxiety and depression were also consistent with norms in the UK.

The study authors speculated about several possible reasons for the differences between their findings and other studies. While AALPHI examined only anxiety and depression, other studies looked at a wider range of mental health issues.

There were also considerable sociodemographic differences between patients included in this study and similar studies in the US that found higher rates of anxiety and depression among young people with PHIV. While the patients in this study were primarily black African females who migrated to the UK and had no evidence of drug misuse, many of the patients in the US studies came from families with a history of substance abuse and psychiatric disorders.

“Our findings underscore the need for young people with PHIV to be regularly screened for mental health problems,” Le Prevost and colleagues concluded.

The study, “Anxiety and depression symptoms in young people with perinatally acquired HIV and HIV affected young people in England,” was published this month in AIDS Care.

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