Bipolar Disorder is Associated with HIV Transmission Risk Behavior Among Patients in Treatment for HIV
Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 90519, Durham, NC, 27708, USA, .AIDS and Behavior (Impact Factor: 3.49). 05/2012; 16(8):2267-71. DOI: 10.1007/s10461-012-0203-4
This study examined HIV transmission risk behavior among 63 patients with bipolar disorder (BD), major depressive disorder, and no mood disorder; half had substance use disorders (SUDs). Patients with BD were more likely than others to report unprotected intercourse with HIV-negative partners and <95 % adherence to antiretroviral medications. In multivariate models, BD and SUD were independent predictors of both risk behaviors. Participants with poorer medication adherence were more likely to have detectable HIV viral loads and unprotected intercourse with HIV-negative partners. Patients with BD deserve careful evaluation and HIV prevention services to reduce HIV transmission risk behaviors.
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ABSTRACT: There has been a general recognition of a syndemic that includes HIV/AIDS and serve mental illnesses including schizophrenia, major depression, bipolar disorder, post-traumatic stress disorder, and others. The pathophysiology and direction of effects between severe mental illness and HIV infection is less clear however, and relatively little work has been done on prevention and treatment for people with these complex, co-occurring conditions. Here we present the most recent work that has been published on HIV and mental illness. Further, we describe the need for better treatments for "triply diagnosed persons"; those with HIV, mental illness, and substance abuse and dependence. Finally, we describe the potential drug-drug interactions between psychotropic medications and anti-retrovirals, and the need for better treatment guidelines in this area. We describe one example of an individually tailored intervention for persons with serious mental illness and HIV (PATH+) that shows that integrated community-based treatments using advanced practice nurses (APNs) as health navigators can be successful in improving health-related quality of life and reducing the burden of disease in these persons.
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ABSTRACT: Background: This study assesses among 200 HIV-infected outpatients the prevalence of positive alcohol use disorder (AUD) and its correlations with socio-demographic characteristics, life habits, sexual behavior and (hypo) manic symptoms. Methods: Between December 2009 and June 2011, patients were interviewed at the specialized clinic for HIV care located in Walter Cantídio’s University Hospital, Fortaleza, Ceará, Brazil. Screening for AUD was performed with the Alcohol Use Disorders Identification Test (AUDIT). A socio-demographic questionnaire based on WHO’s Behavioral Surveillance Surveys was used to track risky sexual behaviors. The Mood Disorder Questionnaire (MDQ) was used to screen for symptoms of mania and hypomania. Results: One hundred thirty-three patients (66.5%) were male, mean age of 37.4 years (standard deviation, SD=10.9) and mean years of study of 9.5(SD=3.5). Ninety nine patients (49.5%) had AUD: 80 (40%) had hazardous drinking and 19 (9.5%) had alcohol dependence. AUD patients had higher rates of male gender (OR=2.8; 95%CI=1.5, 5.2), living alone (OR=4.5; 95%CI=1.6, 12.7), use of tobacco (OR=3.0; 95%CI=1.4, 6.6), use of illicit drugs (OR=3.5; 95%CI=1.7, 7.1) and (hypo)manic symptoms (OR=6.4; 95%CI=2.3, 17.7). Regarding sexual behavior, AUD was associated with lower age at first sex (OR=1.1; 95%CI=1.05, 1.2) and higher prevalence of commercial (OR=2.7; 95%CI=1.3, 5.8) and non-regular sex partners (OR=4.3; 95%CI=2.1, 8.6). In multivariate analysis, independent associations between AUD and the following variables were found: manic symptoms (adjusted Odds Ratio [aOR]=10.1; 95%CI=2.3, 44.7), living alone (aOR=7.8; 95%CI=1.5, 39.0), tobacco use (aOR=3.9; 95%CI=1.2, 12.2), male gender (aOR=3.4; 95%CI=1.4, 8.3), sex with non-regular partners (aOR=2.7; 95%CI=1.1, 6.6), lower education (aOR=1.1; 95%CI=1.03, 1.2) and lower age (aOR=1.03; 95%CI=1.002, 1.076). Conclusion: Therefore, there is a significantly high prevalence of AUD among HIV-infected patients. AUD showed the following profile: young males, living alone, with lower education, higher rates of (hypo) manic symptoms and drug and sexual risk behaviors. A better understanding of AUD comorbidity and its implications on behavioral aspects of HIV-positive individuals may help in providing better long term outcomes of these patients.
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