Depression high among HIV-positive patients

Rates are more than five times greater

Researchers studying the prevalence of psychiatric disorders among HIV-positive patients have found a 57.3% prevalence of depression among HIV-infected patients and a 69.8% prevalence of depression among people coinfected with HIV and hepatitis C.

The psychiatric disorders that were studied included depression, general anxiety disorder, panic disorder, and substance abuse, says Dina Hooshyar, MD, infectious disease fellow at the University of North Carolina, Chapel Hill, where the research was conducted.

In a general adult population of primary care patients, the prevalence of depression is estimated to range from 5% to 10%, she notes. The study looked at patients receiving HIV primary care from the university’s clinic, which serves a rural population, Hooshyar says.

In all, 726 HIV-infected patients and 215 co-infected patients were included in the study. All were adults who consented to having their data included, she adds.

Investigators also found that patients who were coinfected with HIV and HCV were 1.99 times more likely to have problems with psychiatric disorders than were the patients who were infected with HIV only, Hooshyar points out.

Substance abuse also was higher among the HIV patients than among the general population. An estimated 8.3% of the U.S. population, age 12 and up, has a problem with substance abuse, according to recent statistics, she says.

By contrast, researchers found that 28.8% of HIV-infected patients had a problem with substance abuse, and 47.9% of HIV/HCV coinfected patients had a problem with substance abuse, Hooshyar notes.

The results showed that coinfected patients are 2.55 times more likely to have problems with substance abuse than patients infected with only HIV, she adds. "The other interesting thing we found was concurrent psychiatric and substance abuse problems in 36% of the coinfected patients vs. 20% of those mono-HIV-infected."

"These are very striking results and have great and important ramifications," explains Hooshyar. "One obvious one is that half of our patients with HIV or HIV/HCV coinfection have a life confounded by psychiatric disorders, while 30% to 50% have trouble with substance-abuse disorders."

These results show the importance of placing more funding in areas of substance abuse therapy and mental illness treatment, she says.

Another issue is that interferon use in treatment for hepatitis C is associated with new depression in patients, so clinicians may need to consider identifying and treating, when appropriate, their patients who have HCV prior to their initiation of interferon therapy, Hooshyar suggests.

Clinicians and their assistants should screen HIV patients for mental disorders and substance abuse and refer patients to counseling and care when it’s needed, she says.

Clinicians should keep in mind that if they don’t bother to ask their patients about these issues they might not learn the truth because patients often won’t volunteer the information, Hooshyar says.

One of the reasons depression is so common among HIV patients may be the way HIV infection continues to be stigmatized in our society, she asserts.

Patients already may feel depressed about having a chronic illness, and then they are told they’ll need to take medication for the rest of their lives, Hooshyar explains.

"If you were asked to take five pills a day for the rest of your life and you were feeling depressed, then your adherence and general welfare would begin to go down," she adds.