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Session 171
Poster Abstracts Mental Health and Substance Abuse Wednesday, 1:30 - 3:30 pm Hall B |
Background: Information
regarding the prevalence of mental illness and substance abuse among
HIV-infected individuals and impact on HIV treatment and outcomes is needed.
Previous studies have been limited by a focus on patients with mental illness or
substance abuse, thus prohibiting examination of both disorders together and
their combined effects on antiretroviral treatment and progression of disease.
Methods: We
used the UW HIV Information System capturing comprehensive clinical data for
the cohort of HIV-infected patients receiving care at a university-based HIV
specialty clinic to examine the prevalence of psychiatric and substance abuse disorders
and their effect on antiretroviral treatment.
Results: Among patients
served at the HIV clinic during 2003 (n = 1479), 64% had a mental illness (diagnosed
primarily by psychiatric staff), 46% had a substance abuse disorder, and 38%
had both. Approximately 75% of patients with mental illness and/or substance
abuse received highly active antiretroviral therapy (HAART), similar to the
proportion of all clinic attendees. However, among clinic patients treated with
HAART, a significantly higher proportion with mental illness and/or substance
abuse had a CD4 count < 350 cells/mm3 or HIV-1 RNA level > 20,000/ml
compared with patients without mental illness or substance abuse (44% vs 36%, p
< 0.005).
|
Type of Substance Abuse |
#/(%) Patients* |
#/(%) Substance Abuse Pts with Mental Illness |
Type of Mental Health Disorder |
#/(%) Patients* |
#/(%) Mentally Ill Pt with Substance Abuse |
|
Amphetamine |
217 (15%) |
181 (83%) |
Cognitive |
157 (11%) |
103 (66%) |
|
Cocaine |
250 (17%) |
214 (86%) |
Mood |
858 (58%) |
510 (59%) |
|
Alcohol |
439 (30%) |
377 (86%) |
Anxiety |
520 (35%) |
349 (67%) |
|
Opioid |
177 (12%) |
150 (85%) |
Psychotic |
144 (10%) |
117 (81%) |
|
Sedative/hypnotic/anxiolytic |
22 (1%) |
20 (91%) |
Personality |
150 (10%) |
121 (81%) |
|
Polysubstance |
113 (8%) |
110 (97%) |
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*Patients may be included in
more than one category
Conclusion: Our results demonstrate
a high prevalence of mental illness and substance abuse among an urban HIV
clinic population and suggest that patients with these disorders are more
likely to receive HAART at a lower CD4 cell count and higher viral load than
patients without psychiatric and substance abuse disorders. Further understanding
of the impact of these disorders on adherence to HAART and long-term outcomes
will aid in development of more effective treatment strategies for HIV-infected
persons with mental illness and substance abuse.
Keywords: mental illness; substance abuse; antiretroviral therapy
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