Psychological effects of HAART: a 2-year study
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J G Rabkin1, S J Ferrando, S H Lin
1Department of Psychiatry, Weill College of Medicine, Cornell University, Ithaca, NY, USA. jgr1@Columbia.edu
Insights
Combination antiretroviral therapy showed modest psychological benefits for men with symptomatic human immunodeficiency virus (HIV). Physical symptoms, not viral load, most impacted mental health and distress levels.
Area of Science:
- Psychiatry
- Infectious Diseases
- Public Health
Background:
- Symptomatic human immunodeficiency virus (HIV) infection presents significant psychological challenges.
- Combination antiretroviral therapy (ART) has transformed HIV management, but its psychological impact requires ongoing evaluation.
Purpose of the Study:
- To assess the psychological effects of ART on mood, hope, and life satisfaction in men with symptomatic HIV.
- To compare psychological outcomes between patients whose health improved and those whose health did not improve with ART.
Main Methods:
- 173 HIV-positive gay and bisexual men with symptomatic illness were evaluated semiannually.
- Primary outcome measures included depression, quality of life, and hopelessness scales.
Main Results:
- A modest, statistically significant reduction in psychological distress was observed overall.
- Declines in clinical depression rates were noted, influenced by CD4 cell count, HIV symptoms, and social support.
- Individual medical improvement did not correlate with greater psychological distress reduction.
Conclusions:
- A cohort effect indicated overall psychological improvement during the early widespread use of ART.
- Physical symptoms were more strongly associated with psychological distress than laboratory markers of HIV progression.
- Successful viral suppression did not necessarily alleviate the psychological burden of illness.
Objective:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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