The Prevalence of Mood Disorders and Neurocognitive Impairments in People with HIV
Recent studies highlight a significant prevalence of mood disorders and neurocognitive impairments in people with HIV (PWH). Even with effective antiretroviral therapy (ART) and viral suppression, neurocognitive impacts such as mild neurocognitive disorder (MND) and HIV-associated neurocognitive disorder (HAND) remain prevalent. These disorders are exacerbated by multiple stressors, including stigma and comorbid chronic illnesses, which often contribute to mental health challenges. Depression is notably prevalent in PWH, often exacerbated by the stress of managing a chronic illness and social stigma. A growing number of studies find high rates of depression in PWH across diverse regions. Addressing these mental health challenges is key as the population of aging adults with HIV grows significantly.
Studies indicate that despite achieving viral suppression, neurocognitive disorders persist in many PLWH. The prevalence of HAND, ranging from asymptomatic neurocognitive impairment to more severe conditions, remains a concern due to its impact on quality of life and daily functioning (Winston & Spudich, 2020; Munoz-Moreno et al., 2021). Treatment with antiretroviral therapy (ART) has mitigated severe forms of HAND but has not completely eliminated cognitive impairments. Global data reveal regional variations in HAND prevalence, influenced by access to ART, cultural factors, and socioeconomic conditions. Cognitive impairment remains a global challenge. This suggests that while ART addresses virological suppression, other factors like immune activation and systemic inflammation may play roles (Bandera et al., 2019; Matacotta, Tran & Yoon, 2024).
Mood disorders, including depression and anxiety, significantly reduce functionality and quality of life in PLWH. These effects are particularly pronounced in older adults, who face additional aging-related challenges (Muller-Oehring et al, 2021). The Matacotta, Tran & Yoon study aimed to evaluate the burden of HIV and major depressive disorder (MDD) in underrepresented populations. The study also assessed the frequency of the HIV/MDD comorbidity using data from the NIH All of Us Research Program. A cross-sectional analysis was performed using survey and electronic health record (EHR) data. Key findings included high prevalence of MDD in PWH compared to AoU participants without HIV and PWH were 2.8 times more likely to have MDD than participants without HIV. Medical comorbidities were common in people with HIV and MDD, with essential hypertension and anxiety disorders ranking among the highest. The study underscored significant disparities in HIV prevalence in Black individuals and mental health burdens in people with HIV. It further emphasized the intertwined nature of HIV and MDD, highlighting the need for integrated behavioral health care tailored to specific populations.
HIV remains a significant risk factor for mental health issues like MDD, particularly in underrepresented groups. Integrating mental health services within HIV care is crucial. The intersection of neurocognitive and mood disorders in PWH underscores the importance of integrating mental health services into HIV care. Addressing stigma, enhancing ART regimens to mitigate neuroinflammation, and tailoring interventions to youth and older adults are critical steps forward.
