June 14, 2004
Researchers at the University of North Carolina-Chapel Hill, found a 57.3 percent prevalence of depression among HIV-infected patients and a 69.8 percent prevalence of depression among patients coinfected with HIV and hepatitis C (HCV). Psychiatric disorders examined in the study included depression, general anxiety disorder, panic disorder and substance abuse, said Dina Hooshyar, M.D., infectious disease fellow at the university.
In a general adult population of primary care patients, the prevalence of depression is estimated at 5-10 percent, Hooshyar noted. The current study looked at patients receiving HIV primary care from the university's clinic, which serves a rural population.
In the study, researchers included 726 HIV patients and 215 coinfected patients, all adults. Hooshyar pointed out that coinfected HIV-HCV patients were 1.99 times more likely to have psychiatric disorders than patients with HIV only.
Substance abuse, which affects an estimated 8.3 percent of the U.S. population ages 12 and up, affected 28.8 percent of HIV-infected patients in the study, Hooshyar said. She noted that 47.9 percent of HIV/HCV-infected patients indicated substance abuse.
Study results showed that coinfected patients are 2.55 times more likely to be affected by substance abuse than patients with HIV only. "The other interesting thing we found was concurrent psychiatric and substance abuse problems in 36 percent of the coinfected patients vs. 20 percent of those mono-HIV-infected," Hooshyar noted. "These are very striking results and have great and important ramifications. One obvious one is that half of our patients with HIV or HIV/HCV coinfection have a life confounded by psychiatric disorders, while 30 percent to 50 percent have trouble with substance abuse disorders," Hooshyar said. The findings show the importance of more funding for substance abuse therapy and mental illness treatment, she added.
Another issue is that interferon use in treating hepatitis C is associated with new depression in patients, so clinicians may need to consider identifying and treating, when appropriate, HCV patients prior to initiating interferon therapy, Hooshyar suggested, adding that clinicians and their staff should screen HIV patients for mental disorders and substance abuse and refer patients to counseling and care when needed. Clinicians should ask patients about these issues, she said, because patients often will not volunteer such information.
Hooshyar said that one reason depression is common among HIV patients is the stigma attached to the disease. In addition, patients could react badly to knowing they will need to take medicine for the rest of their lives, she said.