Human Immunodeficiency Virus Illness Research Articles

Estimated Use of Prescription Medications Among Individuals Incarcerated in Jails and State Prisons in the US

Although incarcerated individuals experience higher rates of chronic conditions, little is known regarding the use of prescription medications in jails and prisons in the US. To characterize treatment with prescription medications in jails and state prisons relative to noncorrectional settings in the US. This cross-sectional analysis using 2018 to 2020 data from the National Survey on Drug Use and Health (NSDUH) estimated the prevalence of disease among recently incarcerated and nonincarcerated adults in the US. The study used 2018 to 2020 IQVIA's National Sales Perspective (NSP) to quantify the distribution of medications to incarcerated and nonincarcerated populations. The NSP provides national dollar and unit sales of prescription medications across multiple distribution channels, including prisons and jails. The study population included incarcerated and nonincarcerated individuals from NSDUH. Seven common chronic conditions were assessed. Data were analyzed in May 2022. Medications being sent to correctional facilities vs all other settings in the US. The main outcomes were distribution of medications to treat diabetes, asthma, hypertension, hepatitis B and C, human immunodeficiency virus (HIV), depression, and severe mental illness to incarcerated and nonincarcerated populations. The proportion of pharmaceuticals distributed to jails and state prisons to treat type 2 diabetes (0.15%), asthma (0.15%), hypertension (0.18%), hepatitis B or C (1.68%), HIV (0.73%), depression (0.36%), and severe mental illness (0.48%) was much lower compared with the relative burden of disease among this population. The incarcerated population in state prisons and jails accounted for 0.44% (95% CI, 0.34%-0.56%) of estimated individuals with diabetes, 0.85% (95% CI, 0.67%-1.06%) of individuals with asthma, 0.42% (95% CI, 0.35%-0.51%) of hypertension, 3.13% (95% CI, 2.53%-3.84%) of hepatitis B or C, 2.20% (95% CI, 1.51%-3.19%) of HIV, 1.46% (95% CI, 1.33%-1.59%) of depression, and 1.97% (95% CI, 1.81%-2.14%) of severe mental illness. After adjusting for disease prevalence, the relative disparity was 2.9-fold for diabetes, 5.5-fold for asthma, 2.4-fold for hypertension, 1.9-fold for hepatitis B or C, 3.0-fold for HIV, 4.1-fold for depression, and 4.1-fold for severe mental illness. In this cross-sectional, descriptive study of the distribution of prescription medications for chronic conditions in jails and state prisons, the findings suggest that there may be underuse of pharmacological treatment in correctional facilities relative to the nonincarcerated population. These findings, which require further investigation, may reflect inadequate care in jails and prisons and represent a critical public health issue.

Mental Health and Cognitive Care for Successful Aging with HIV

Purpose of the article: Globally, an estimated 4.2 million people above the age of 50 now have diagnosis of HIV (Human Immunodeficiency Virus) infection. Patients with HIV can now survive well into old age. Aging with HIV has been associated with medical illness however neuropsychiatric symptoms including cognitive decline and behavioral dysregulation has been directly associated with aging and having HIV. The article will talk about common neuropsychiatric diagnosis with HIV and discuss some interventions that may be used for successful aging with HIV. Findings: A detailed literature review using indexed peer reviewed literature using databases such as Medline, PubMed and Cochrane reviews show that untreated HIV illness over a long period of time can both cause both cognitive and behavioral changes as well as precipitate underlying existing illnesses. All providers are encouraged to begin treatment with Highly Active Antiretroviral Therapy (HAART). Early screening for both behavioral and cognitive disorders is encouraged and timely referrals to mental health professionals is of utmost importance. Conclusion: Persons with HIV now have increased longevity given newer and more innovative treatment with anti-retroviral treatment (ART). However, persons with HIV are at increased risk for both neurological and psychiatric illness. Early detection, assessment and treatment are key to ensure aging successfully. A collaborative multidisciplinary team comprising of individuals from infectious diseases, mental health, social work and nursing is essential for optimal neuropsychiatric health in older persons with HIV.

An HIV Narrative of Female Inmates With a Lifetime History of Mental Illness in Durban, South Africa.

Introduction: South Africa (SA) has one of the highest prevalence rates of Human Immuno-deficiency Virus (HIV) globally, with women carrying a larger burden of the disease. Furthermore, female inmates have higher rates of HIV compared to their male counterparts, with an over-representation of mental illnesses among female inmates as well. Additionally, mental illnesses are highly prevalent in people living with HIV, with HIV and mental illness sharing a complex bidirectional relationship. This study, which forms part of a larger two-phased, mixed-methods study, describes the experiences of contracting and living with/being affected by HIV, among female inmates with a lifetime history of mental illness, in a South African setting.Method: This study was conducted at a correctional centre in Durban, KwaZulu-Natal, SA. Fourteen adult (18 years and older) female inmates, were purposively selected to participate in individual, in-depth semi-structured interviews. Participants had a lifetime history of mental illness, trauma and were either living with HIV, or affected by HIV. Women from diverse cultural backgrounds, who were fluent in English, were selected. This manuscript focuses on the description of the HIV component of the qualitative interviews only. Thematic analysis was used to analyse the data.Results: Themes related to contracting HIV included intimate partner betrayal, gender differences regarding sexual behaviour, fear associated with HIV and the importance of pre- and post-test HIV counselling. Themes related to living with/being affected by HIV included the challenges women experienced in their home community, which contrasted with their experience of living with HIV in the prison community, and the importance of accepting an HIV positive life.Conclusion: HIV is prevalent in the female inmate population at this correctional centre in SA. This study emphasises that whilst incarcerated, attempts should be made to educate, train, support and manage HIV in this population, thereby helping to curb the epidemic. Further research should aim at exploring such strategies. The study also underscores the importance of the continued need for HIV education in order to eradicate associated stigma and discrimination which are still prevalent in SA.

Population Pharmacokinetics and Significant Under-Dosing of Anti-Tuberculosis Medications in People with HIV and Critical Illness

Critical illness from tuberculosis (TB) bloodstream infection results in a high case fatality rate for people living with human immunodeficiency virus (HIV). Critical illness can lead to altered pharmacokinetics and suboptimal drug exposures. We enrolled adults living with HIV and hospitalized with sepsis, with and without meningitis, in Mbarara, Uganda that were starting first-line anti-TB therapy. Serum was collected two weeks after enrollment at 1-, 2-, 4-, and 6-h post-dose and drug concentrations quantified by validated LC-MS/MS methods. Non-compartmental analyses were used to determine total drug exposure, and population pharmacokinetic modeling and simulations were performed to determine optimal dosages. Eighty-one participants were enrolled. Forty-nine completed pharmacokinetic testing: 18 (22%) died prior to testing, 13 (16%) were lost to follow-up and one had incomplete testing. Isoniazid had the lowest serum attainment, with only 4.1% achieving a target exposure over 24 h (AUC0–24) of 52 mg·h/L despite appropriate weight-based dosing. Simulations to reach target AUC0–24 found necessary doses of rifampin of 1800 mg, pyrazinamide of 2500–3000 mg, and for isoniazid 900 mg or higher. Given the high case fatality ratio of TB-related critical illness in this population, an early higher dose anti-TB therapy should be trialed.

HIV and mental illness in Malawi and the neuropsychiatric sequelae of efavirenz.

Little is published about mental disorders in Malawi, specifically in relation to Human Immunodeficiency Virus (HIV) and it's treatment. Efavirenz is a medication commonly used as part of triple therapy for HIV treatment. Indeed, in 2013, Malawi introduced 5A with Efavirenz as part of it's 1st line treatment for HIV. There exists some literature documenting known psychiatric side effects of Efavirenz, which include anxiety, mood changes, nightmares, psychosis and suicidal ideation. Little is known about what features are most common in the presentation and what factors in the patient and drug which may make this reaction more likely. The aim of this commentary is to review the association between HIV and psychiatric disorder, and consider the neuropsychiatric side-effects of Efavirenz. An evaluative literature review was completed by means of multiple electronic database search as well as an additional manual search to obtain published works identified through the electronic search. Search terms used were: Efavirenz, Acquired Immunodeficiency Syndrome, Africa, Antiretroviral Therapy, Developing Countries, Malawi, Mental Disorders, Public Health, and Psychiatry. This is an important area of study, as potentially large numbers of individuals with HIV are being placed on Efavirenz as first line treatment, yet 60% may experience some form of neuropsychiatric side effects.

Extremely prolonged HIV seroconversion associated with an MHC haplotype carrying disease susceptibility genes for antibody deficiency disorders

Severe immunodeficiency during primary human immunodeficiency virus (HIV) infection is unusual. Here, we characterized viral and immunological parameters in a subject presenting with Pneumocystis jirovecii pneumonia in the setting of prolonged primary HIV illness and delayed seroconversion. HIV antibody was only detected by enzyme-linked immunosorbent assay 12 months after presentation, and Western blot profiles remain indeterminate. Isolated virus was of R5 phenotype, exhibited poor viral fitness, but was otherwise unremarkable. Analysis of HIV antibody isotypes showed failure to mount a detectable HIV IgG response over nearly 2 years of infection, in particular IgG(1)- and IgG(3)-specific responses, despite normal responses to common infections and vaccines. Genetic analysis demonstrated homozygosity for part of an MHC haplotype containing susceptibility genes for common variable immunodeficiency (CVID) syndrome and other antibody deficiency disorders. Thus, a primary disorder of specific antibody production may explain exceptionally slow antibody development in an otherwise severe seroconversion illness. This highlights the need for multiparameter testing, in particular use of a fourth generation HIV test, for confirming HIV infection and underscores the importance of host factors in HIV pathogenesis.

Impact of Bereavement on Progression of AIDS and HIV Infection: A Review

Human immunodeficiency virus (HIV) disease is associated with bereavement and grief reactions brought about by the disease process itself and by the losses of loved ones. The goal of this review is to assess the current literature regarding grief, HIV, and immunity. The authors reviewed applicable articles retrieved from a MEDLINE literature search with the search terms "bereavement/HIV," "grief/HIV," and "immunity/grief/HIV." Data continue to emerge that suggest a profound role for bereavement in mediating HIV illness and the need to effectively deal with bereavement issues. Patients who experience maladaptive grief show more rapid losses of CD4 T-cells over time, even when controlling for age, health status, use of antiretrovirals, and illicit drug abuse. This immune dysfunction may be managed by a variety of psychotherapeutic techniques.

Sex-Ethnic Disparities in HIV-Related Hospitalization and Mortality in Florida

Purpose To determine the racial/ethnic-differences in characteristics of inpatients hospitalized for Human immunodeficiency virus (HIV) disease/illness by gender and the correlates of HIV-related mortality in Florida. Methods A retrospective analyses of public use data from the Florida Agency for Health Care Administration (AHCA), 2001 was utilized. From the de-identified hospital discharge file, discharge records with primary diagnosis of HIV disease/illness using the International Classification of Diseases, Ninth Edition (ICD 9) code were included. There were 9,279 inpatient records with diagnoses of HIV disease or illness. However, 9,113 records that belonged to black, white, and Hispanic patients were included in the analyses. The differences between sex-race/ethnic groups were tested using the chi-square tests and general linear models. In addition, multivariable logistic regression models were fitted to evaluate the correlates of HIV-related mortality in Florida Hospitals. Results Of 9,113 records, 64%, 23%, and 13% of records belonged to blacks, whites, and Hispanics, respectively. The type of admission, discharge status, length of hospital stay, health insurance status and age differed in six sex-, race/ethnic-specific groups. HIV-related mortality was significantly correlated with insurance status, age, and length of hospital stay. Under- or uninsured patients were about 27% more likely to die than those patients who had commercial health insurance. Older individuals (> 40 years) and those who stayed in hospitals more than 6 days were at higher risks of death compared with their reference groups (≤ 40 years old and ≤ 6 days of hospital stay). Conclusion The potential causes (severity of disease, co-infections, preventive care, socio-economic status, cultural norms and beliefs about HIV) of disparities between sex-, race/ethnic-groups of Florida should be further explored.

Human immunodeficiency virus and depression in primary care: a clinical review.

Human immunodeficiency virus (HIV)-infected individuals are at increased risk of developing depression. Depressive syndromes in these patients pose a challenge both diagnostically and therapeutically. These syndromes reflect both the presence of preexisting mood disorders and the development of depressive syndromes subsequent to HIV infection. A search of the literature to 2005 was performed using the PubMed and Ovid search engines. English- and Portuguese-language articles were identified using the following keywords: HIV or AIDS and depression, mental illness, suicide, fatigue, psychiatry, and drug interactions. Additional references were identified through bibliography reviews of relevant articles. The clinical presentation and differential diagnosis of depressive symptoms in HIV illness and the role of HIV in the development of these conditions are reviewed. Management issues including suicide assessment and treatment options are then discussed, and potentially important pharmacokinetic interactions are reviewed. Individuals with HIV show higher rates of depression. This phenomenon may be due to a preexisting psychiatric disorder or to the HIV infection. Untreated depression symptoms may lead to non-compliance with drug regimens or increased high-risk behaviors. Given the adverse sequelae of untreated depressions in HIV illness, identification and management of depression are integral components of comprehensive HIV care.

The connections between childhood sexual abuse and human immunodeficiency virus infection: Implications for interventions

A qualitative study was conducted with 28 women who are human immunodeficiency virus (HIV)–positive and have experienced childhood sexual abuse (CSA) in order to examine (1) the challenges generated by the experience of sexual abuse and related coping strategies, (2) the impact of the HIV diagnosis on their coping strategies, and (3) the links perceived by the women between their CSA and HIV infection. The interviews revealed that CSA raised challenges in four areas: disclosure of the abuse, sexual problems, relationship difficulties, and psychological distress. The women used two strategies to cope with their CSA: illicit substances to numb their emotional distress and sexual activity, and alienation to gain control in relationships. When diagnosed with HIV, the women initially coped with their illness by using these two strategies. The women reported that, over time, they were able to accept their HIV illness, seek social support, find alternative sources of significance, and use spirituality to sustain their growth. However, they continued to suffer psychological distress related to their sexual trauma. Further, most of the women did not perceive any connection between the two traumas. Implications of these findings for secondary prevention interventions with women who have HIV and experience of CSA are discussed. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 655–672, 2005.

Musculoskeletal disorders associated with HIV infection and AIDS. Part I: infectious musculoskeletal conditions.

The musculoskeletal system can be affected by a variety of abnormalities in association with human immunodeficiency virus (HIV) infection. Although not as common as complications involving other organ systems, such as the pulmonary and the central nervous systems, HIV-associated musculoskeletal disorders are sometimes the initial presentation of the viral illness. Knowledge of the existence and the characteristic appearance of the conditions affecting bone, joint, and muscle in HIV-infected patients is valuable to radiologists for diagnosis and to clinicians for detection and appropriate treatment. We reviewed recent literature to provide a comprehensive assessment of the HIV-associated musculoskeletal disorders, and present radiologic examples from our own collection. This article is divided into two parts. In the first part we review the infectious musculoskeletal disorders associated with HIV illness and AIDS, including cellulitis, abscesses, pyomyositis, septic bursitis, septic arthritis, osteomyelitis, and bacillary angiomatosis. We also present a comprehensive spectrum of mycobacterial infections, consisting of tuberculous spondylitis and spondylodiskitis, arthritis, osteomyelitis, and tenosynovitis, as well as infections caused by atypical mycobacteria. Part II of this review will concentrate on non-infectious musculoskeletal conditions, including rheumatic disorders and neoplasms.

Predictors of employment of men with HIV/AIDS: a longitudinal study.

To identify patterns and predictors of work status and number of hours employed in a group of men with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). A total of 141 participants had semiannual neuropsychiatric, psychosocial, and medical assessments over a period of 30 months. These six occasions provided the basis for identifying patterns of employment (part-time, full-time, or unemployed). Those who completed neuropsychological testing, introduced at visit 4, constitute the sample used to identify predictors of number of hours employed, using multiple regression analysis with mixed procedure. Over 30 months, 20% were continuously employed full-time, another 9% were continuously employed part-time, and 40% were continuously unemployed. Employment status changed for 31%: 4% who worked at baseline stopped, 13% started or increased their hours, 8% decreased their hours, and 6% showed a fluctuating pattern. The major parameters consistently associated with unemployment or partial employment, in order of influence, were financial (disability benefits), psychiatric (past/current diagnosis of major depression and/or dysthymia), medical (physical limitations), cognitive (executive function), and education. In contrast, age, ethnicity, laboratory markers of HIV illness status, vocational rank, and past or current substance dependence did not predict work status. Overall, those who worked continued to work. However, despite improved health, most men who were unemployed at study baseline did not return to work. Structure of disability benefits, lifetime depressive disorder, physical limitations, and impairment in some areas of cognitive function each appear to represent significant barriers to work. Returning to work is evidently difficult, and clinicians may keep this in mind when recommending leaving work unless medically necessary. Specific interventions and policy changes regarding disability benefits may be needed to promote return to work for people with HIV/AIDS whose health is restored and who contemplate re-employment.

Acquired Protein C and Protein S Deficiency in HIV-Infected Patients

Infection with human immunodeficiency virus (HIV) may lead to hemostatic imbalances. Forty-nine consecutive patients with acute opportunistic infections were screened for thrombophilic parameters. A follow-up investigation was performed after 10 +/- 8 weeks in 26 patients. In acutely ill patients, the incidence of protein S deficiency was 67% (33/49) and of protein C deficiency 25% (12/49), while at the follow-up visit the incidences were 54% (14/26) and 8% (2/26), respectively. Protein S and protein C levels increased significantly from initial to follow-up visit (p < 0.05). Lupus anticoagulants were not detected and anticardiolipin IgG antibodies were present in 11.4% (5/44). Three patients presented with deep venous thrombosis on admission; in two, protein S or protein C deficiency was observed. In conclusion, an acquired protein S and protein C deficiency often develop in patients with HIV and acute illness; this may be reversible after treatment for opportunistic infections.

Medical Treatment of Children with HIV Illness and the Need for Supportive Intervention: The Challenges for Medical Providers, Families, and the State

ABSTRACTHuman immuno‐deficiency virus (HIV) illness in children poses tremendous challenges to medical providers and families to work together to deliver optimal care. An alternative to filing “neglect” reports with the Department of Social Services is necessary to provide support and appropriate intervention to families and medical providers caring for HIV‐positive children.The creation of a neutral entity that could intervene and identify barriers to treatment and communication between the medical providers and the family would benefit all the parties involved. Knowledgeable mediators could help facilitate communication and identify appropriate support for the child and family.Intervention would not be delayed until it is demonstrated that a child has been “neglected” or is at substantial risk of harm. Assistance could be made available without a finding that a parent was guilty of wrongdoing. Involving parents as full partners in medical decision making and monitoring would benefit children living with HIV now and in the future. The creation of an alternative process will also prove valuable in assisting providers and families caring for other medically at‐risk children, e.g., children with asthma, diabetes, or mental illness.

Maternal adherence to the zidovudine regimen for HIV-exposed infants to prevent HIV infection: a preliminary study.

To describe the extent of adherence to the recommended neonatal zidovudine (ZDV) regimen administered to infants who have been exposed to the human immunodeficiency virus (HIV) to prevent mother-to-child transmission of HIV and to determine which maternal factors are associated with compliance. HIV-infected women (n = 87) who were participating in a larger study of perinatal transmission at 3 inner-city New York City hospitals were interviewed 2 to 6 weeks' postpartum to assess adherence to neonatal prophylaxis, social support, social network factors, and depression. In addition, plasma samples of 45 of their infants were assayed for ZDV levels. A majority of women (71%) administered all of the prescribed 4 daily doses in the previous week, as measured by interview; self-reported adherence was not associated with any maternal characteristics. In contrast, poor adherence, as measured by lower infant ZDV plasma levels, was associated with asymptomatic HIV illness in the mother and having 2 or more other children; good adherence, as indicated by higher ZDV levels, was associated with the presence of a maternal social support network, disclosure of HIV infection, and mothers' adherence to their own ZDV regimens during pregnancy. In multivariate regression analyses, maternal asymptomatic status (beta = -0.40) was associated with lower infant ZDV levels, and maternal adherence during pregnancy (beta = 0.37) was associated with higher levels. Women who are HIV asymptomatic and lack a social support network are more likely not to comply with the recommended neonatal prophylactic regimen of antiretroviral therapy. Future studies should address the prenatal period and social network factors, such as disclosure of serostatus, and the custody of other children.

Virus load during primary Human Immunodeficiency Virus (HIV) type 1 infection is related to the severity of acute HIV illness in Kenyan women.

We evaluated the association between the severity of primary human immunodeficiency virus type 1 (HIV-1) illness and HIV-1 plasma virus load before seroconversion using stored plasma samples obtained from 74 prostitutes in Mombasa, Kenya. Fever, vomiting, headache, fatigue, arthralgia, myalgia, sore throat, skin rash, or being too sick to work were each associated with significantly higher virus loads before HIV-1 seroconversion, and each additional symptom or sign was associated with an increase in virus load of 0.4 log(10) copies/mL.

I'm not a "basabasa" woman: an explanatory model of HIV illness in Ghanaian women.

Ghana continues to experience an increase in the rate of infection with the human immunodeficiency virus (HIV), with more new infections occurring in women than in men. Prevailing views of health and illness, including indigenous knowledge and traditional beliefs, are an important component of the broad context of disease transmission. Participatory action research was used to explore the explanatory model of HIV illness of 31 seropositive Ghanaian women. Also interviewed were 5 HIV seropositive men, 2 traditional healers, 8 nurses, and 10 professionals, individually and in focus groups, to reflect on the women's comments and the themes emerging from the data. In this article, the women's beliefs about HIV illness will be discussed and their views about the etiology, pathophysiology, symptomology, course of illness, and methods of treatment for their illness will be described. Findings illustrate areas of divergence and convergence between traditional and biomedical explanations of, and treatment for, HIV illness. The necessity for health professionals, particularly nurses, to understand individual and community perceptions about HIV illness is highlighted by the study findings.

Use of mental health and substance abuse treatment services among adults with HIV in the United States.

The need for mental health and substance abuse services is great among those with human immunodeficiency virus (HIV), but little information is available on services used by this population or on individual factors associated with access to care. Data are from the HIV Cost and Services Utilization Study, a national probability survey of 2864 HIV-infected adults receiving medical care in the United States in 1996. We estimated 6-month use of services for mental health and substance abuse problems and examined socioeconomic, HIV illness, and regional factors associated with use. We estimated that 61.4% of 231 400 adults under care for HIV used mental health or substance abuse services: 1.8% had hospitalizations, 3.4% received residential substance abuse treatment, 26.0% made individual mental health specialty visits, 15.2% had group mental health treatment, 40.3% discussed emotional problems with medical providers, 29.6% took psychotherapeutic medications, 5.6% received outpatient substance abuse treatment, and 12.4% participated in substance abuse self-help groups. Socioeconomic factors commonly associated with poorer access to health services predicted lower likelihood of using mental health outpatient care, but greater likelihood of receiving substance abuse treatment services. Those with less severe HIV illness were less likely to access services. Persons living in the Northeast were more likely to receive services. The magnitude of mental health and substance abuse care provided to those with known HIV infection is substantial, and challenges to providers should be recognized. Inequalities in access to care are evident, but differ among general medical, specialty mental health, and substance abuse treatment sectors.

Describing an explanatory model of HIV illness among aboriginal women.

This article describes the explanatory model of human immunodeficiency virus (HIV) illness used by aboriginal women in northern Alberta. Using Kleinman's explanatory model framework, eight women who were HIV positive were interviewed to determine their perspectives on the etiology, pathophysiology, symptomology, course of illness, and methods of treatment for HIV. A comparative analysis was done between the explanatory model of HIV illness as described by participants and the conventional biomedical paradigm of HIV disease. As described by aboriginal women, several aspects of the explanatory model of HIV were congruent with the biomedical paradigm. It was also found that the findings related to etiology and treatment of HIV illness was incongruent with the conventional biomedical paradigm of HIV disease. These findings highlight the relevance of knowing models of illness for health care professionals, particularly nurses who work in communities with a high incidence of HIV/AIDS. These models make care planning of patients with HIV and AIDS more focused and directed.

Psychological Effects of HAART: A 2-Year Study

The objectives of this study were to evaluate the psychological consequences of combination antiretroviral treatment in terms of mood, hope, and life satisfaction in men with symptomatic human immunodeficiency virus (HIV) infection or acquired immune deficiency syndrome and to compare those whose health improved with those whose health did not improve. One hundred seventy-three HIV+ gay or bisexual men with symptomatic HIV illness (40% nonwhite) were evaluated semiannually in a university-affiliated research program between July 1995 and December 1997. The primary outcome measures were the Structured Clinical Interview for DSM-IV, Beck Depression Inventory, Endicott Quality of Life Enjoyment and Satisfaction Questionnaire, and Beck Hopelessness Scale. Psychological distress in this sample was mild to moderate at baseline. During the first 2 years that highly active antiretroviral therapy became widely available, we observed a statistically significant but clinically modest reduction in distress in the sample as a whole, with significant covariates of CD4 cell count, HIV symptoms, and social support in a mixed-effects model. Rates of clinical depression declined. However, this generalized mental health improvement was not related to individual medical improvement of markers of HIV illness progression; those classified as improved were no more likely than those who remained unimproved to report greater declines in measures of distress and hopelessness. Number of self-reported physical symptoms were directly related to distress levels. A cohort effect was observed, with overall psychological improvement. Physical symptoms were more strongly related to psychological distress than were laboratory markers. Consequently, those whose CD4 cell count and HIV RNA viral load reflected successful treatment were no more likely than others to be relieved of the psychological burdens of illness.