Antonio Camiro

Mental health is at the core of the HIV epidemic, and has been an important topic of investigation in our response to it. In this oral abstract session, we reviewed relevant research into the impact of mental health in the clinical outcomes of people living with HIV.

Dr. Dang showed the immunologic effects of IV opioid use on HIV patients from needle exchange programs in Miami. HIV and Opioid use were each associated with immune activation and inflammation, but the effect is greatest in the PLWH using opioids. Dr. Patel talked about the impact of stigma on the presence of depression, anxiety disorders and alcohol-use disorder on a longitudinal cohort of transgender women in India. Legal and medical gender affirmation, as well as resiliency resources, were variably associated with reduced outcomes. Stigma was consistently related to the presence of all outcomes. Dr. Brown presented the IMPAACT 2002 trial, a combined cognitive-behavioral therapy and medication algorithm for the treatment of depression in youth living with HIV in the USA. When compared with the standard of care, patients presented higher proportion treatment responses, which was maintained by week 48 of follow-up. The intervention appeared to have no impact on CD4 counts or viral load. Dr. Jeanne showed the risk of hospitalization and chronic disease among children who were HIV-exposed but HIV-uninfected in a longitudinal cohort study in Montreal. Across a median follow-up of 11 years, exposed children had increased risks of hospitalization, neuropsychiatric disorders and congenital anomalies.

Chronic injection opioid use, exacerbates immune dysfunction in HIV infection, and may pose a risk for comorbidities in this population. The presence of stigma is related to mental health disorders in transgender women, interventions that increase system’s gender affirmation and improve resiliency resources could help reduce their incidence. Combined cognitive-behavioral therapy and medication algorithms are feasible in clinic settings and are more effective than the standard of care in combating depression amongst HIV-infected youths. Even in resource rich settings, HIV-exposure increases the risk of hospitalization and neuro-psychiatric disorders in children who clearly are in need of enhanced pediatric care.