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Substance Abuse and Psychiatric Disorders in HIV-Positive Patients

Epidemiology and Impact on Antiretroviral Therapy

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Abstract

There is a high prevalence of substance abuse and psychiatric disorders among HIV-infected individuals. Importantly, drug and alcohol-use disorders are frequently co-morbid with depression, anxiety and severe mental illness. Not only do these disorders increase the risk of contracting HIV, they have also been associated with decreased highly active antiretroviral therapy (HAART) utilisation, adherence and virological suppression. The literature evaluating the relationship between substance abuse and HIV outcomes has primarily focused on injection drug users, although there has been increasing interest in alcohol, cocaine and marijuana. Similarly, the mental health literature has focused largely on depression, with a lesser focus on severe mental illness or anxiety. To date, there is little literature evaluating the association between co-occurring HIV, substance abuse and mental illness on HAART uptake, adherence and virological suppression. Adherence interventions in these populations have demonstrated mixed efficacy. Both directly observed therapy and pharmacist-assisted interventions appear promising, as do integrated behavioural interventions. However, the current intervention literature has several limitations: few of these studies are randomised, controlled trials; the sample sizes have generally been small; and co-occurring substance abuse and mental illness has not specifically been targeted in these studies. Future studies examining individual substances of abuse, psychiatric disorders and co-occurring substance abuse and psychiatric disorders on HIV outcomes will inform targeted adherence interventions.

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Acknowledgements

This research is supported by the National Institute of Alcohol Abuse and Alcoholism K23 AA015313 (Chander) and by the National Institute of Drug Abuse (NIDA) K23 DA 019820 (Himelhoch) and NIDA K24 DA00432. The authors have no conflicts of interest directly relevant to the contents of this article.

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  1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Geetanjali Chander & Richard D. Moore

  2. Department of Psychiatry, University of Maryland Medical Center, Baltimore, Maryland, USA

    Seth Himelhoch

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  1. Geetanjali Chander
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  2. Seth Himelhoch
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Correspondence to Geetanjali Chander.

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Chander, G., Himelhoch, S. & Moore, R.D. Substance Abuse and Psychiatric Disorders in HIV-Positive Patients. Drugs 66, 769–789 (2006). https://doi.org/10.2165/00003495-200666060-00004

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