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49 Psychiatric Co-morbidity in HIV Infected Youth Sharon Nachman Stony Brook Univ, NY, USA |
Background: As the HIV epidemic enters its third decade, advances in treatment have transformed the disease from a rapidly fatal infection to a chronic illness. Newer complications, such as psychiatric comorbidity, possibly related to both HIV and its treatments, are emerging. Psychological manifestations in children with life-threatening or chronic illnesses have been reported, with results suggesting that disease, social support, and quality and access to care all play a role. Children with HIV have additional risk factors, such as poverty, disrupted home life, family history of mental illness and or substance abuse, disclosure, fear of progression and body image concerns all playing a role. Other factors influencing the development of psychiatric disorders include direct effects of HIV on developing brains, differential neurotoxicity of HAART resistant viruses, co-infection by other neurotropic viruses, and possibly direct and indirect toxicity of antiretrovirals. Recent reviews of published data evaluating psychiatric disorders in HIV-infected youth suggest that >25% of HIV-infected youth have concurrent psychiatric disorders. These include major depressive disorders, mood disorders, anxiety disorders, and conduct disorders. The rates of these disorders significantly increases (up to 85% in some studies) when HIV+ youth infected via adult behaviors are evaluated. Unfortunately, many of these studies are compromised by methodological issues such as small sample sizes, specific demographics, or lack of long-term follow-up. Recent data evaluating psychiatric hospitalizations in a large cohort of perinatally HIV-infected youth (PACTG 219C) observed that psychiatric hospitalization rates were more than double compared with rates in uninfected children of the same ages. In addition to the effect that HIV has on the development of psychiatric problems, there is a real and significant effect that co-existing psychiatric issues play in the treatment of HIV-infected youth. For example, medication compliance is decreased in children with depression and its treatment may need to be considered to ensure that HAART therapy is successful. Conclusions: In summary, the presence of HIV is associated with psychiatric symptoms and diagnoses. Further studies are needed to evaluate the contribution that the virus, medications, family, and social issues play on the development of psychiatric pathology in HIV infected youth.
Keywords: early; treated; infants
