October 25, 2002
-- Key findings of a national physician and patient survey conducted by the International Association of Physicians in AIDS Care (IAPAC) demonstrate a strong link between HIV infection and the mental health of patients diagnosed with HIV disease. According to physician respondents, more than 80% of their HIV-positive patients suffer from symptoms of depression or anxiety. Although psychiatric symptoms in patients with HIV infection have a variety of causes, including the direct CNS [central nervous system] effects of HIV, CNS opportunistic infections, and street drugs, the majority of surveyed physicians also believe that HIV medications (antiretroviral drugs) are a leading cause of their patients' most common mental health symptoms (83.6%). The results of the survey, which queried more than 130 HIV-treating physicians and 235 HIV-positive men and women, were presented today in Chicago, in conjunction with the 40th Annual Meeting of the Infectious Disease Society of America (IDSA).
"These data clearly demonstrate that physicians must take seriously the psychiatric condition of their HIV-positive patients," said Ewald Horwath, M.D., Associate Clinical Professor of Psychiatry at the College of Physicians and Surgeons of Columbia University. "As physicians, we must more aggressively evaluate HIV-positive patients for psychiatric symptoms. This may require a medical work-up to rule out CNS opportunistic diseases, cognitive evaluation to rule out HIV-associated dementia, review of antiretroviral regimens for agents that cause CNS side effects, and referral for psychiatric consultation." Horwath, who analyzed the survey results, has authored a supplement to IAPAC's quarterly scientific peer-reviewed journal, JIAPAC, which focuses on HIV and mental health issues, incorporating data from the survey.
In the survey, more than eighty percent (84.3%) of physicians said that their HIV-positive patients frequently or very frequently suffered from symptoms of depression. Anxiety (81.4%), headaches (74.6%), lethargy (72.3%), and insomnia (71.5%) were highlighted as the most common symptoms in HIV-positive patients according to their physicians.
Patients being treated for HIV did corroborate the physicians' findings with regard to common symptoms experienced, with 72% experiencing depression and 65% experiencing anxiety. Lethargy (43%), irritability (41%), impaired concentration (40%), and mood swings (40%) were also leading symptoms experienced by patients.
To treat these symptoms, physicians most frequently prescribed antidepressant drugs (79.6%) to patients and also recommended that patients switch from their current antiretroviral therapies to other regimens (56.6%), where specific antiviral agents may be responsible.
"It is important that we continually look for ways to improve the quality of care and support provided to all people living with HIV disease, and not take for granted that the full spectrum of care issues has been adequately charted," said IAPAC President/CEO José M. Zuniga. "Addressing mental health concerns is a critical, and often neglected step toward ensuring that patients receive the most appropriate treatment to control their HIV, while maintaining an optimal quality of life."
Physician and patient survey questionnaires were developed by IAPAC in coordination with Horwath. IAPAC gathered physician responses through 15-minute telephone interviews and signed fax-back response sheets, conducted with a segment of its US physician members. IAPAC contracted Wirthlin Worldwide, an independent market research firm, to field the patient questionnaire via an online survey hosted on www.thebody.com, a leading patient-oriented HIV/AIDS information Web site. Funding for the survey was provided by an educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.