HIV and Mental Health- Under Graduate 2021 (1)

Page 1: Introduction

• John JoskaEmail: John.Joska@uct.ac.zaDivision of NeuropsychiatryGROOTE HIV Mental Health SCHUUR Research UnitHOSPITAL

Page 2: Aim

• Primary Objective:To reduce morbidity and mortality associated with HIV and co-morbid mental disorders.

  • Strategies:

    • Minimize behaviors leading to HIV acquisition.

    • Ensure early HIV testing and engagement in care by reducing stigma and mental health issues.

    • Address mental disorders in People Living with HIV/AIDS (PLWHA) to enhance Antiretroviral Therapy (ART) adherence.

    • Support and rehabilitation for secondary and tertiary prevention of mental disorders.

Page 3: Assumptions

• Definitions and Understanding:

  • Acknowledgment of mental disorders and phenomena as known concepts.

  • Awareness that neuropsychiatric disorders can arise from multiple causes.

  • Recognition of the impact of mental disorders on functionality and quality of life.

  • Understanding HIV as a chronic infectious agent affecting the immune system and various organs; treatable but currently incurable.

Page 4: State of the HIV Epidemic: South Africa

• HIV Statistics (2019):

  • Eastern and Southern Africa: 20.7 million living with HIV, 730,000 new infections, 300,000 deaths.

  • Western and Central Africa: 4.9 million living with HIV, 240,000 new infections, 140,000 deaths.

  • Global Overview:

    • 38.0 million people living with HIV

    • 1.7 million new infections, 690,000 AIDS-related deaths.

  • Treatment Progress:

    • 72% of people living with HIV in the region on treatment, 65% with suppressed viral loads.

Page 5: Care Cascade in HIV Treatment

• HIV Testing and Treatment Cascade:

  • Out of individuals living with HIV, significant gaps exist in awareness and treatment steps.

  • 87% aware of their status, 72% on treatment, and 65% virally suppressed.

Page 6: HIV and Stigma

• Public Perception Questions:

  • Would you buy food from someone with HIV?

  • Would you care for a family member with AIDS?

  • Should an HIV-positive teacher continue their role?

  • Attitudes revealing stigma:

    • 34.3% of HIV-positive respondents report psychological distress due to stigma.

    • Study reference: Ncitakalo et al., 2021.

Page 7: Visual Representation of Stigma

• Mental Illness Stigma Image

  • Visual aid shows societal attitudes toward mental illness and HIV.

Page 8: Importance of Mental Health in HIV

• Behavioral Acquisition of HIV:

  • Modes of HIV acquisition: unprotected intercourse and drug use.

  • Behaviors mediate engagement in HIV care, including testing and adherence.

  • HIV also infects and affects the brain, altering mental health.

Page 9: Bio-Psycho-Social Determinants of Mental Disorders

• Key Determinants:

  • Biological, psychological, and social factors influencing mental health in the context of HIV.

    • Examples include trauma, genetics, socioeconomic status, and exposure to stress.

Page 10: Specific Determinants in HIV

• Mental Disorders in HIV:

  • Consideration of stigma, disclosure, socio-economic pressures, and the biological impact of HIV as determinants of mental health.

Page 11: Relationship Between HIV and Mental Disorders

• Neuropsychiatric Impacts of HIV:

  • Risk behaviors, poor insight, impulsivity, and disorganized behavior may be heightened.

  • HIV effects include brain involvement, neurotoxicity, and stress reactions.

Page 12: NeuroHIV Consequences

• Untreated NeuroHIV Implications:

  • Development of HIV Encephalitis when neuroHIV is left untreated.

Page 13: Prevalence of Psychiatric Disorders

• Prevalence Statistics:

  • Highlights disorders within PLWHA, comparing various studies:

    • Major Depression: 36.0%, Dysthymic Disorder: 26.5%.

    • Any substance/alcohol use disorder: 50.1%.

  • Sources: Various psychiatric studies including HCSUS, HSRC, and NCS-R.

Page 14: DSM-V Criteria for Psychiatric Disorders

• Diagnostic Criteria:

  • Affects identifying and excluding other potential mental health diagnoses.

Page 15: Neuropsychiatric Syndromes in HIV

• Common Syndromes/Disorders:

  • Range from depressive disorders to severe mental illness and neurocognitive disorders.

  • Notably, medication side effects (e.g., Efavirenz) may present moderate to severe consequences.

Page 16: Depression in HIV

• Understanding Depression:

  • Symptoms include anhedonia and thoughts of death.

  • Depressive disorders' lifetime prevalence is double that of the general population.

  • Effects include poor treatment adherence and quality of life issues.

  • Suicidal ideation is a significant risk factor among HIV patients.

Page 17: Depressive Disorder Continuum

• Types of Depressive Disorders in HIV:

  • Ranges from Major Depressive Disorder (MDD) to adjustment disorders influenced by other factors (e.g., alcohol).

Page 18: Adjustment and Anxiety Disorders

• Responses to Stress:

  • Adjustment disorder prevalence noted to be 30%, while PTSD and GAD also show significant rates among affected populations.

Page 19: Substance Use Disorder (SUD) and Distress

• SUD Progression Tracking:

  • Use of AUDIT and SAMISS to assess distress and substance use behavior over time.

Page 20: Alcohol and Substance Abuse in HIV

• Impact on Care Engagement:

  • Alcohol misuse linked to lower ART adherence rates.

  • Risk factors and management of substance use in HIV positive individuals.

Page 21: Challenges of Alcohol Abuse in HIV

• Consequences of Alcohol Use:

  • 10-40% prevalence of alcohol use disorders and its consequent effects on adherence and health outcomes.

  • Treatment approaches including identification and motivation strategies required.

Page 22: HIV and Severe Mental Illness (SMI)

• Interrelationship:

  • Higher incidence of HIV among individuals with pre-existing SMI, highlighting dual stigma and treatment resistance.

Page 23: HIV-Associated Psychosis

• Characteristics & Treatment:

  • Occurs primarily in late-stage HIV. Symptoms include altered consciousness, hallucinations, and mood changes.

  • Typically responsive to combination antiretroviral therapy (CART).

Page 24: Neurocognitive Disorders in HIV

• Neurocognitive Impairment:

  • Describes deficits in cognitive functions influenced by HIV affecting various brain structures.

Page 25: HIV-Associated Dementia (HAD)

• Clinical Presentation:

  • Often signals a late-stage HIV condition; differential diagnosis is crucial to exclude other conditions.

  • Subcortical dementia characterized by motor, cognitive, and behavioral symptoms.

Page 26: Impact of HIV-associated Neuropsychiatric Disorders

• Clinical Impact:

  • Impacts daily functioning, with common challenges in motivation, concentration, and memory.

Page 27: Functional Impairment Due to Neurocognitive Issues

• Self-Reported Functionality:

  • Significant differences in daily activities and functioning between neurocognitive impairment and normal ranges.

Page 28: Self-Reported Impairment Observations

• Assessment Validity:

  • Challenges reported in assessing self-reported impairments; combines personal, collateral, and objective assessments for accuracy.

Page 29: Summary

• Overall Clinical Insights:

  • Nearly all patients with HIV are affected cognitively by neuroHIV.

  • Access to ART can mitigate neuroHIV but does not eliminate comorbid mental disorders.

  • Treatment remains effective for psychiatric disorders, significantly improving quality of life, adherence, and overall health outcomes.