Psychiatric context of acute/early HIV infection. The NIMH multisite Acute HIV infection study: IV

AIDS and Behavior (Impact Factor: 3.49). 12/2009; 13(6):1061-1067. DOI: 10.1007/s10461-009-9585-3
Source: PubMed


Acute/early HIV infection is a period of high risk for HIV transmission. Better understanding of behavioral aspects during
this period could improve interventions to limit further transmission. Thirty-four participants with acute/early HIV infection
from six US cities were assessed with the Mini International Diagnostic Interview, Beck Depression Inventory II, State-Trait
Anxiety Inventory, Brief COPE, and an in-depth interview. Most had a pre-HIV history of alcohol or substance use disorder
(85%); a majority (53%) had a history of major depressive or bipolar disorder. However, post-diagnosis coping was predominantly
adaptive, with only mild to moderate elevations of anxious or depressive mood. Respondents described challenges managing HIV
in tandem with pre-existing substance abuse problems, depression, and anxiety. Integration into medical and community services
was associated with adaptive coping. The psychiatric context of acute/early HIV infection may be a precursor to infection,
but not necessarily a barrier to intervention to reduce forward transmission of HIV among persons newly infected.

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Available from: Jenny Higgins, Feb 16, 2014
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    • "Therefore, maladaptive coping with stigma in this context is likely among PLWHA who concur with negative public stereotypes. Internalized stigma might be indicated by the elevated levels of psychological distress often observed in samples of HIV infected persons, either pre-and post-HIV testing or among the treatment experienced (Arendt 2006; Atkinson, Higgins, Vigil, Dubrow, Remien, Steward, et al. 2009; Berger, Schad, von Wyl, Ehlert, Zellweger, Furrer, et al. 2008; Burack, Barrett, Stall, Chesney, Ekstrand & Coates 1993; Eller, Corless, Bunch, Kemppainen, Holzemer, Nokes, et al. 2005; Gore-Felton & Koopman 2008; Ickovics, Milan, Boland, Schoenbaum, Schuman & Vlahov 2006; Kaharuza, Bunnell, Moss, Purcell, Bikaako-Kajura, Wamai, et al. 2006; Leserman 2008; Owe-Larsson, Sall, Salamon & Allgulander 2009). Therefore, screening for psychosocial distress might help identify PLWHA who are at risk of internalizing public stigma in Zambézia Province. "
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    ABSTRACT: Abstract Stigma has been implicated in poor outcomes of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) care. Reducing stigma is important for HIV prevention and long-term treatment success. Although stigma reduction interventions are conducted in Mozambique, little is known about the current nature of stigma and the efficacy and effectiveness of stigma reduction initiatives. We describe action research to generate consensus on critical characteristics of HIV stigma and anti-stigma interventions in Zambézia Province, Mozambique. Qualitative data gathering methods, including in-depth key-informant interviews, community interviews and consensus group sessions, were utilized. Delphi methods and the strategic options development analysis technique were used to synthesize qualitative data. Key findings are that stigma enacted by the general public might be declining in tandem with the HIV/AIDS epidemic in Mozambique, but there is likely excessive residual fear of HIV disease and community attitudes that sustain high levels of perceived stigma. HIV-positive women accessing maternal and child health services appear to shoulder a disproportionate burden of stigma. Unintentional biases among healthcare providers are currently the critical frontier of stigmatization, but there are few interventions designed to address them. Culturally sensitive psychotherapies are needed to address psychological distress associated with internalized stigma and these interventions should complement current supports for voluntary counseling and testing. While advantageous for defining stakeholder priorities for stigma reduction efforts, confirmatory quantitative studies of these consensus positions are needed before the launch of specific interventions.
    Full-text · Article · Feb 2014 · SAHARA J: journal of Social Aspects of HIV/AIDS Research Alliance / SAHARA , Human Sciences Research Council
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    • "Clinical studies have suggested that neuropsychological performance and indices of mood may be worse in subjects with early HIV infection compared with those in HIV-uninfected control subjects or published norms [55, 56]. Deficits are similar in pattern to those seen in subjects with chronic, treated HIV infection, including impairments in learning and processing speed. "
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    ABSTRACT: The spectrum of HIV-associated neurocognitive disorder (HAND) has been dramatically altered in the setting of widely available effective antiretroviral therapy (ART). Once culminating in dementia in many individuals infected with HIV, HAND now typically manifests as more subtle, though still morbid, forms of cognitive impairment in persons surviving long-term with treated HIV infection. Despite the substantial improvement in severity of this disorder, the fact that neurologic injury persists despite ART remains a challenge to the community of patients, providers and investigators aiming to optimize quality of life for those living with HIV. Cognitive dysfunction in treated HIV may reflect early irreversible CNS injury accrued before ART is typically initiated, ongoing low-level CNS infection and progressive injury in the setting of ART, or comborbidities including effects of treatment which may confound the beneficial reduction in viral replication and immune activation effected by ART.
    Preview · Article · Jul 2013 · Current HIV/AIDS Reports
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    • "This is the first in a series of five papers in this issue of the journal (see Remien et al. 2009; Steward et al. 2009; Atkinson et al. 2009; Kelly et al. 2009) that describe results from the National Institute of Mental Health (NIMH) Multisite Acute HIV Infection Study, an exploratory study with the aims of determining the feasibility of detecting and recruiting individuals with AHI into research studies; better understanding the social and psychological context of recent HIV transmissions; and assessing sexual behavior, substance use, and the psychological state of individuals during the periods before and after diagnosis. This research provides formative results to inform development of effective prevention interventions for persons with acute/early HIV infection. "
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    ABSTRACT: Acute/early HIV infection plays a critical role in onward HIV transmission. Detection of HIV infections during this period provides an important early opportunity to offer interventions which may prevent further transmission. In six US cities, persons with acute/early HIV infection were identified using either HIV RNA testing of pooled sera from persons screened HIV antibody negative or through clinical referral of persons with acute or early infections. Fifty-one cases were identified and 34 (68%) were enrolled into the study; 28 (82%) were acute infections and 6 (18%) were early infections. Of those enrolled, 13 (38%) were identified through HIV pooled testing of 7,633 HIV antibody negative sera and 21 (62%) through referral. Both strategies identified cases that would have been missed under current HIV testing and counseling protocols. Efforts to identify newly infected persons should target specific populations and geographic areas based on knowledge of the local epidemiology of incident infections.
    Full-text · Article · Dec 2009 · AIDS and Behavior
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