by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

August 6, 2019

Featured Literature:
Beer, al. for the Medical Monitoring Project

Generalized anxiety disorder symptoms among persons with diagnosed HIV in the United States. AIDS: September 1, 2019 – Volume 33 – Issue 11 – p 1781–1787
doi: 10.1097/QAD.0000000000002286

Mental health issues including depression, anxiety, and substance use disorder are common in persons living with HIV (PLWH). This study is from the CDC’s Medical Monitoring Project (MMP). The MMP is a national surveillance system coordinated by CDC along with state and local health departments designed to understand the experiences and needs of PLWH and help guide HIV prevention and care efforts. This study estimated the overall prevalence of generalized anxiety disorder (GAD) symptoms among HIV-infected adults.

The authors included data on 3,654 persons that was obtained between June 2015 and May 2016 and calculated the weighted prevalence of symptoms of GAD. The overall estimated prevalence of GAD symptoms was 19%. Having symptoms of GAD was associated with significantly lower adherence to ART, lack of sustained viral suppression, and decreased engagement in care. Those with GAD also had more emergency room visits and hospitalizations. Having symptoms of GAD also correlated with a higher prevalence of condomless sex. Lastly, these patients were more than three times likely to have an unmet need (23% vs 7%) for mental health services. The authors encourage routine screening for GAD in clinical practice settings to improve health outcomes, reduce HIV transmission, and lessen health care costs.

Author’s Commentary:

This data should not be surprising to those who provide direct patient care to PLWH. However, seeing the many adverse outcomes for those whose GAD is not being addressed is disheartening. Models of care have been developed in which mental health providers are integrated into clinical locations to provide and improve access to services. Our HIV program and most of the practices in our health care system began using this model about two years ago. We currently have a therapist on site two days each week who is able to see patients on the same day or soon after their visit with a medical provider. They can also facilitate direct referral to a psychiatrist for more intensive medical therapy if indicated. 

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