Background: People with HIV experience a high burden of mental health problems, but the extent to which this is due to HIV specifically is unclear. We compared the prevalence of depression and anxiety between people with HIV and a matched ''at risk'' HIV-negative group.
Methods: HIV-negative individuals in the AURAH study, recruited from UK GUM clinics (2013-14) were matched (with replacement) to HIV-positive individuals in the ASTRA study, recruited from UK HIV-outpatients (2011-12). Individuals aged 30-69 years were included. Matching variables were: gender/sexual orientation; age; ethnicity; education level. Depressive symptoms [PHQ-9 score≥10/27], anxiety symptoms [GAD-7 score≥10/21], and depression overall [subject report of current medical or other therapy for depression, and/or major or other depressive disorder on PHQ-9], were compared between HIV-positive and HIV-negative groups, using logistic generalised estimating equations, adjusted for matching variables, accounting for repeated observations. The HIV-positive group was assessed overall, and split by: (i) ART/VL status; (ii) time since HIV diagnosis.
Results: 2699 HIV-positive and 759 unique HIV-negative individuals (2699 matches with replacement) were included; mean age 45 years; 73% MSM; 16% women; 17% Black African ethnicity; 44% university education. Prevalences for HIV-positive versus HIV-negative were: 26.5% vs 11.5% for depressive symptoms [adjusted odds ratio, aOR(95%CI): 3.2(2.4,4.3)]; 21.2% vs 10.9% for anxiety symptoms [2.7(2.0,3.6)]; 34.5% vs 16.3% for depression overall [2.6(2.0,3.3)]. For each measure, odd ratios for HIV-positive versus HIV-negative were elevated across all ART/VL categories, and increased steadily with longer time since HIV diagnosis. For example, for depression overall, compared to HIV-negative, aOR were 2.5(1.9,3.2) for on ART with VL≤50c/mL, 3.6(2.6,5.1) for on ART with VL>50c/mL and 2.6(1.9,3.6) for not on ART, and 1.6(1.1,1.2), 2.2(1.6,3.0), 2.4(1.8,3.2), 2.9(2.2,3.9), 3.3(2.4,4.4) and 4.1(2.9,5.8) for time since HIV diagnosis < 2, 2-5, 5-10, 10-15, 15-20 and ≥20 years respectively.
Conclusions: These results give further evidence that living with HIV has a considerable adverse impact on mental health. The effect was evident among those recently diagnosed, but longer time since diagnosis appears to be a crucial additional factor, which may reflect poorer HIV prognosis in earlier years and/or psychological, socio-economic or biological effects of ageing with HIV.