HIV Virologic Suppression and Mental Well-being in Adolescents and Young Adults Living with HIV.

Abstract

Background and objective: Human Immunodeficiency Virus (HIV) care programs in resource-limited settings reserve counseling and referral for individuals with identified mental illness for those with HIV virological treatment failure (VTF). Adolescence is a period that may increase the likelihood of internalizing psychiatric disorders (IPDs). We assessed the relationship between HIV VTF and symptoms of IPDs among adolescents and young adults (AYA) living with HIV in Gaborone, Botswana.

Methods: A cross-sectional study was conducted in Botswana from December 2018 to December 2019 among AYA living with HIV aged 12-24 years. Logistic regression analysis was used to examine relationships between age, sex, and HIV VTF (≥400 copies/mL) and clinically relevant IPD symptoms, namely, depression (Patient Health Questionnaire-9 score of ≥10) and anxiety (Generalized Anxiety Disorder-7 score of ≥10).

Results: Of 553 participants, most were aged 16-19 years (53%) with an equal sex distribution; the minority had VTF using HIV viral load (VL) cutoff levels of ≥400 copies/mL (11%). Close to one-sixth (15%) had clinical depression symptoms; participants aged 16-19 years and 20-24 years were more likely to have clinically relevant depression symptoms when compared to participants who were aged 12-15 years (odds ratio [OR] 3.160, 95% confidence interval [CI] 1.094-9.123 and OR 4.748, 95% CI 1.624-13.877, p = 0.0117, for participants aged 15- 19 years and 20-24 years, respectively). Participants with clinically relevant anxiety symptoms (11%) or both clinically relevant anxiety and depression symptoms (8%) did not differ from those without these symptoms by age, gender, or VTF status. Similar results were observed using HIV VL cutoff levels of <1000 copies/mL.

Conclusion and global health implications: HIV VTF may be a poor proxy for mental well-being among AYAs receiving HIV. Universal screening should be considered for AYA receiving care for HIV.