The anxiety care continuum and its association with viral suppression among persons with HIV.

Objective: It is unclear how often anxiety is diagnosed and treated and whether anxiety treatment is associated with improved viral suppression in persons with HIV. In this study, we characterized the anxiety care continuum and its association with viral suppression in a large urban HIV clinic in the United States.

Design: Observational cohort study.

Methods: We described the anxiety care continuum by combining data on self-reported anxiety symptoms, engagement in mental health care, clinical diagnoses and prescriptions from 1967 persons receiving HIV care and treatment in Baltimore, Maryland, from 2014 to 2023. We examined cross-sectional associations with viral suppression. All analyses were stratified by sex and race/ethnicity; a secondary analysis adjusted for age, years in care, and depressive symptoms.

Results: Nearly one in five patients reported mild-severe symptoms of anxiety but were not currently receiving mental health care or pharmacologic treatment for anxiety; 6% of patients reported anxiety symptoms but were receiving treatment, and 7% had been treated for anxiety that was currently in remission. The prevalence of viral suppression ranged from 87% to 89% across the anxiety care continuum except among patients with untreated moderate-severe anxiety, only 81% of whom were virally suppressed [95% confidence interval (CI): 80, 83]. In adjusted models, untreated moderate-severe anxiety remained associated with viral nonsuppression across demographic groups.

Conclusion: We observed a robust association between untreated anxiety and viral nonsuppression in a large urban cohort of persons with HIV. Screening for anxiety may identify patients with unmet mental health care needs who face barriers to maintaining viral suppression.