Neuropsychiatric sequelae of medication non-adherence in people living with HIV

Debora Moreira; Rida Khan; Paulo Marcelo Gondim Sales; Debora Moreira; Rida Khan; Paulo Marcelo Gondim Sales

doi:10.3934/medsci.2023014

AIMS Medical Science

2023, Volume 10, Issue 2: 162-173. doi: 10.3934/medsci.2023014

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Neuropsychiatric sequelae of medication non-adherence in people living with HIV

1.
Independent researcher, Brazil
2.
Independent researcher, USA
3.
Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, USA

Received: 08 September 2022 Revised: 21 May 2023 Accepted: 07 June 2023 Published: 13 June 2023

Non-adherence to anti-retroviral therapy (cART) among people living with HIV/AIDS (PLWHA) is complex, multifactorial, and leads to increases in viral load, immunosuppression, and HIV burden related to direct CNS virulence and cART re-initiation (i.e., immune reconstitution syndrome). Among behavioral disturbances, which may become long-lasting without proper treatment, major depressive disorder, generalized anxiety disorder, schizophrenia, and bipolar spectrum disorders are frequent, as well as exacerbation of other premorbid underlying psychiatric conditions, such as post-traumatic stress disorder (PTSD) and substance use and related conditions, not to mention neurocognitive disorders that are encompassed under the umbrella term of HIV-Associated Neurocognitive Disorders (HAND). In this review, we summarized the neuropsychiatric sequelae of medication non-adherence in PLWHA by utilizing two clinical vignettes to illustrate how syndemic factors may interact and lead to unique presentations.
- HIV-associated dementia,
- anti-retroviral agents,
- medication adherence,
- neurocognitive disorders,
- psychiatric disorders
Citation: Debora Moreira, Rida Khan, Paulo Marcelo Gondim Sales. Neuropsychiatric sequelae of medication non-adherence in people living with HIV[J]. AIMS Medical Science, 2023, 10(2): 162-173. doi: 10.3934/medsci.2023014

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Abstract

Non-adherence to anti-retroviral therapy (cART) among people living with HIV/AIDS (PLWHA) is complex, multifactorial, and leads to increases in viral load, immunosuppression, and HIV burden related to direct CNS virulence and cART re-initiation (i.e., immune reconstitution syndrome). Among behavioral disturbances, which may become long-lasting without proper treatment, major depressive disorder, generalized anxiety disorder, schizophrenia, and bipolar spectrum disorders are frequent, as well as exacerbation of other premorbid underlying psychiatric conditions, such as post-traumatic stress disorder (PTSD) and substance use and related conditions, not to mention neurocognitive disorders that are encompassed under the umbrella term of HIV-Associated Neurocognitive Disorders (HAND). In this review, we summarized the neuropsychiatric sequelae of medication non-adherence in PLWHA by utilizing two clinical vignettes to illustrate how syndemic factors may interact and lead to unique presentations.

Abbreviations

ADC

AIDS Dementia Complex

AIDS

Acquired immunodeficiency syndrome

ANI

Asymptomatic neurocognitive impairment

ATP

Adenosine triphosphate

cART

combination anti-retroviral therapy

CNS

Central nervous system

GAD

Generalized anxiety disorder

HAD

HIV-associated dementia

HAND

HIV-associated neurocognitive disorders

HCL-32

Hypomania checklist 32

HIV

Human Immunodeficiency Virus

IL-1β

Interleukin-1beta

KYN/TRP

Kynurenine-to-tryptophan ratio

MoCA

Montreal Cognitive Assessment

MiND

Minor neurocognitive disorder

NNRTI

Nonnucleoside reverse transcriptase inhibitor

NRTIs

Nucleoside analog reverse transcriptase inhibitors

Protease inhibitor

PLWHA

People living with HIV/AIDS

PHQ-9

Patient Health Questionnaire

PTSD

Post Traumatic Stress Disorder

TNF-α

Tumor necrosis factor-alpha

TSH

Thyroid-stimulating hormone

Use of AI tools declaration

The authors declare they have not used Artificial Intelligence (AI) tools in the creation of this article.

Conflict of interest

All authors declare no conflict of interest in this paper.

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