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| LETTER TO EDITOR |
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| Year : 2014 | Volume
: 1
| Issue : 3 | Page : 46-47 |
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Deadly combo of HIV and mental Ill-health
Kalaivani Annadurai, Geetha Mani, Raja Danasekaran
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Thiruporur, Tamil Nadu, India
| Date of Web Publication | 7-Aug-2014 |
Correspondence Address:
Kalaivani Annadurai
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Thiruporur, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2148-7731.138316
How to cite this article:
Annadurai K, Mani G, Danasekaran R. Deadly combo of HIV and mental Ill-health. Sifa Med J 2014;1:46-7 |
Sir,
Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. [1] Mental health disorders can depress the immune system and lead to an increased viral load, decreased CD4 counts, and accelerate HIV disease progression. [2] HIV/AIDS goes hand-in-hand with mental health disorders but often a neglected issue, since significant stigma is attached to both diseases.
Mental health disorders among HIV patients might be a pre-existing disorder or seen after HIV diagnosis; HIV virus directly contributes to neuropsychiatric problems such as HIV encephalopathy, depression, mania, cognitive disorder, and dementia, often in combination or indirectly in the form of opportunistic infections, which affect the central nervous system resulting in behavioral and cognitive changes associated with the progression of HIV. It may be due to the effect of anti-retroviral therapy, which includes depression, euphoria, hallucination, psychosis, suicidal ideation, sleep disturbance, and anxiety or it may even worsen mental disorders. [3],[4]
Common mental disorders seen among HIV patients were depression, post-traumatic stress disorder, anxiety disorders, mood disorders, personality disorders, and substance abuse. [4] CHASE study done among HIV patients reported that a majority (54%) of HIV patients had a probable mental disorder. [5] Prevalence of depression was found to be two to three times more common in HIV patients than in general population. [6] Conversely, mental ill health patients were four to twenty times more likely to be infected with HIV than general population because of their high risk behaviours. [4]
Occurrence of mental disorder depends on multiple factors such as family history and environmental, biological, and psychosocial factors. Some HIV specific predictors attributing to mental ill-health were stigma and discrimination associated with HIV/AIDS, loss of social support resulting in isolation, loss of employment, hopelessness, changes in physical appearance or abilities due to HIV/AIDS, effects of complicated antiretroviral regimen, and coping with chronic illnesses. [4]
Mental health disorders among HIV patients adversely affects the daily functioning of the person, thereby diminishing the quality of life, affecting drug compliance, interfering with healthy behaviors, and inability in coping with the disease. The resulting co-morbidity complicates health seeking behavior, diagnosis, treatment, adherence, and its outcomes. Moreover, people with HIV and chronic depression were two times at risk of dying than those with HIV alone. [4]
Barriers in seeking mental healthcare services are stigma attached to both HIV and mental disorders, lack of awareness among healthcare professionals to identify and evaluate symptoms of mental disorders associated with somatic disorders, lack of adequate specialists in psychiatry, and lack of adequate medicines. [4],[7]
Treatment for mental illness includes pharmacotherapy and psychotherapies. Providing mental health is a combined duty of psychiatrists, psychologists, therapists, social workers, or nurses. Lacunae in mental healthcare services for HIV patients should be addressed by integration of mental health services with HIV care, adequate training of healthcare professional in mental health. Psychiatric health services should be made mandatory for all people with HIV, initially at the time of diagnosis for coping up with the situation and at regular intervals. Providing social support through non-governmental organization, creating self help groups among PLHIV, involving them in more recreational activities, and reducing the stigma attached with the disease among general population. [4]
To conclude, early identification and treatment of mental disorders should be given utmost priority since it is having stronger effects on the healthcare of patients with HIV/AIDS, both physically and mentally.
| References | |  |
| 1. | World Health Organization. Mental Health. Available from: http://www.who.int/features/qa/62/en/ [Last accessed on 2014 Mar 24]. 
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| 2. | Motivala SJ, Hurwitz BE, Llabre MM, Klimas NG, Fletcher MA, Antoni MH, et al. Psychological distress is associated with decreased memory helper T-cell and B-cell counts in pre-AIDS HIV seropositive men and women but only in those with low viral load. Psychosom Med 2003;65:627-35.
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| 3. | Federal HIV/AIDS Web Council. U.S. Department of Health & Human Services. Available from: http://aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/taking-care-of-yourself/mental-health/ [Last accessed on 2014 Apr 4].
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| 4. | World Health Organization. HIV/AIDS and Mental Health. Report by the secretariat. 2008. Available from: http://apps.who.int/gb/ebwha/pdf_files/EB124/B124_6-en.pdf. [Last accessed on 2014 Apr 4].
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| 5. | Pence BW, Reif S, Whetten K, Leserman J, Stangl D, Swartz M, et al. Minorities, the poor, and survivors of abuse: HIV-infected patients in the US Deep South. South Med J 2007;100:1114-22.
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| 6. | Akena DH, Musisi S, Kinyanda E. A comparison of the clinical features of depression in HIV-positive and HIV-negative patients in Uganda. Afr J Psychiatry 2010;13:43-51.
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| 7. | Chandra PS, Desai G, Ranjan S. HIV & psychiatric disorders. Indian J Med Res 2005;121:451-67.
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