The Role of Mental Health Conditions in the Diagnosis of Neurocognitive Impairment in People Living with HIV.

Irene Portilla-Tamarit,Cristian Alcocer-Bruno,Marcos Díez-Martínez,Rosario Ferrer-Cascales,Joaquín Portilla,Nicolás Ruiz-Robledillo

doi:10.3390/diagnostics10080543

Abstract

The aims of the present study were to evaluate the prevalence of undiagnosed mental health conditions (UMHC) in people living with HIV (PLWHIV) on antiretroviral treatment and with long-term suppressed HIV viremia, and its association with neurocognitive impairment (NCI). A cross-sectional observational study on HIV subjects, ≥18 years old, on stable antiretroviral treatment and with HIV viral load <50 copies/mL was carried out. Patients with known comorbidities, substances abuse, anxiety or depression were excluded. UMHC were evaluated by the Millon Clinical Multiaxial Inventory-III and NCI by Frascati criteria. The association between NCI and sociodemographic, clinical HIV variables and mental health conditions was analyzed. Further, the relationship between mental health conditions scores and NCI diagnosis was evaluated. Eighty patients were included, 37.5% had at least one undiagnosed mental health condition, and 26.3% had NCI. The most frequent mental health conditions were: anxiety (21.3%); bipolar disorder (11.3%); and substance dependence (8.8%). Only longer time since HIV diagnosis (p = 0.030) and at least one mental health condition diagnosis (p = 0.002) showed an association with NCI. Participants with NCI presented higher scores in anxiety, alcohol dependence and post-traumatic stress. Undiagnosed mental health conditions are frequent in PLWHIV. These disorders cannot be identified by HIV clinicians or basic screening questionnaires, and they are not usually self-reported by patients. UMHC could act as confounders in the evaluation of NCI.

Highlights

Neurocognitive impairment (NCI) without an alternative explanation than HIV infection has been described in people living with HIV (PLWHIV) [1]
The most important variables identified in the previous research are based on the heterogeneous population included in the studies, differences in HIV infection control or the lack of the identification of several comorbidities, something that could increase the prevalence of NCI, such as mental health conditions [10,12,13]
Results of the present study show a high prevalence of undiagnosed mental health conditions (UMHC) in PLWHIV without comorbidities with good adherence to antiretroviral therapy (ART) and long-term suppressed viremia

Summary

Introduction

Neurocognitive impairment (NCI) without an alternative explanation than HIV infection has been described in people living with HIV (PLWHIV) [1]. Based on established criteria and the severity of symptoms, NCI is categorized as asymptomatic neurocognitive impairment (ANI), minor neurocognitive disorder (MND) or HIV-associated dementia [2]. This non-AIDS event has severe negative consequences, such as poor adherence to antiretroviral therapy (ART) [3], difficulties. These discrepancies between studies could be related to several factors In this regard, the most important variables identified in the previous research are based on the heterogeneous population included in the studies, differences in HIV infection control or the lack of the identification of several comorbidities, something that could increase the prevalence of NCI, such as mental health conditions [10,12,13]

Objectives

Methods

Results

Discussion

Conclusion