HIV/AIDS and Mental Health

What are HIV and AIDS?

HIV, or human immunodeficiency virus, is the virus that causes AIDS. HIV attacks the immune system by destroying CD4 positive (CD4+) T cells, a type of white blood cell that is vital to fighting off infection. The destruction of these cells leaves people infected with HIV vulnerable to other infections, diseases and other complications.
A person infected with HIV is diagnosed with AIDS when he or she has one or more opportunistic infections (which occur when your immune system is damaged by HIV), such as pneumonia or tuberculosis, and has a dangerously low number of CD4+ T cells (less than 200 cells per cubic millimeter of blood).

People with HIV/AIDS are at a higher risk for mental health disorders.

If you are living with HIV, it is important for you to be aware that you have an increased risk for developing mood, anxiety, and cognitive disorders. For example, people living with HIV are twice as likely to have depression compared to those who are not infected with HIV. These conditions may be treatable. Many people with mental health conditions recover completely.
Some forms of stress can contribute to mental health problems for people living with HIV, including:

• Having trouble getting the services you need
• Experiencing a loss of social support, resulting in isolation
• Experiencing a loss of employment or worries about whether you will be able to perform your work as you did before
• Having to tell others you are HIV-positive
• Managing your HIV medicines
• Going through changes in your physical appearance or abilities due to HIV/AIDS
• Dealing with loss, including the loss of relationships or even death
• Facing the stigma and discrimination associated with HIV/AIDS

The HIV virus itself also can contribute to mental health problems because it enters and resides in your brain. Some other opportunistic infections can also affect your nervous system and lead to changes in your behavior and functioning. Similarly, neuropsychological disorders, such as mild cognitive changes or more severe cognitive conditions, such as dementia , are associated with HIV disease.
You can better manage your overall health and well-being if you know how having HIV can affect your mental health and what resources are available to help you if you need them.

HIV-Associated Neurocognitive Disorders (HAND)

HAND represents the range of neurocognitive complications associated with HIV infection.  Although there is currently no cure for HAND, combination antiretroviral therapy has been shown to be the only option in preventing or delaying the progression of HAND.
There are three major types of HAND:

• Asymptomatic Neurocognitive Impairment (ANI) is diagnosed if testing shows HIV-associated impairment in cognitive function, but everyday functioning is not affected.
• Mild Neurocognitive Disorder (MND) is diagnosed if testing shows HIV-associated impairment in cognitive function, and mild interference in everyday functioning.
• HIV-associated Dementia (HAD) is diagnosed if testing shows marked impairment in cognitive function, especially in learning of new information, information processing, and attention or concentration. This impairment significantly limits your ability to function day-to-day at work, home, and during social activities.

Although a significant proportion of people living with HIV are affected by a mild form of HAND, there has been significant progress in the treatment of HAND.  Since the start of the epidemic, severe cases of HAND have been on the decline and the most severe form, HAD, is rare.  The majority of people experience more subtle abnormalities in memory and cognition.
Experienced clinicians can diagnose HAND after carefully ruling out other possible causes of the symptoms. They may conduct a thorough neurological exam and history, neuropsychological testing, brain MRI scan, and sometimes lumbar puncture to evaluate the cerebrospinal fluid to obtain information about the nature and severity of HAND.

Treatments and Therapies

Research shows that HIV treatment should be initiated as soon as infection is detected to achieve the best health outcomes. Once diagnosed, HIV infection is treated using a combination of medicines called antiretroviral therapy (ART).  Adequate adherence to prescribed treatment regimens, such as taking the medications as prescribed by the health care provider, is critical to controlling the virus and to achieving complete viral suppression. Adequate adherence can be difficult but many strategies have been developed to assist individuals living with HIV/AIDS.
Starting antiretroviral therapy also can affect your mental health in different ways. Sometimes antiretroviral therapy can relieve your anxiety because knowing that you are taking care of yourself can give you a sense of security. However, coping with the reality of living with a chronic illness can be challenging. Depression is one of the most common mental health conditions experienced by people living with HIV, just as it is in the general population. In addition, some antiretroviral medications may cause symptoms of depression, anxiety, and sleep disturbance, and may make some mental health issues worse.
For these reasons, it is important to talk to your health care provider about your mental health. A conversation about mental health should be part of your complete medical evaluation before starting antiretroviral medications. Continue to discuss your mental health with your healthcare team throughout treatment. Be open and honest with your provider about any changes in the way you are thinking, or how you are feeling about yourself and life in general. Also discuss any alcohol or substance use with your provider so that he or she can help connect you to treatment if necessory.
In addition, tell your healthcare provider about any over-the-counter or prescribed medications you may be taking, including any psychiatric medications, because some of these drugs may interact with antiretroviral medications.