Anxiety

A fifth of people living with HIV regularly experience symptoms of anxiety, according to a survey of a representative sample of adults diagnosed with HIV in the United States. A total of 3654 people took part.

An interviewer asked participants: “Over the past two weeks, how often have you been bothered by any of the following problems?” for seven problems such as “feeling nervous, anxious, or on edge” and “not being able to stop or control worrying”.

The questionnaire identifies people with symptoms suggestive of a specific form of anxiety, known as generalised anxiety disorder (GAD). It involves persistent and excessive worry that is difficult to control.

In the survey of people with HIV, 19% had symptoms of generalised anxiety disorder. In the general population of the US, prevalence is 2.7%.

Anxiety was more common in women, people who had a disability, victims of intimate partner violence, people experiencing more HIV stigma, people living in poverty, people with housing problems and people with less education.

Those with anxiety were less likely to be fully engaged with HIV treatment and care, and reported more smoking, drug use and risky sex.

The researchers say this shows the need for better mental health services for people living with HIV.

For more information, read 'Anxiety' in NAM's booklet 'HIV, mental health & emotional wellbeing'.

Starting treatment

There’s new data on whether two specific groups of people – individuals with low viral loads and people with recent HIV infection – are likely to benefit from starting HIV treatment promptly.

In 2015 a large, well-conducted study demonstrated that there are advantages to starting treatment as soon as possible, with high CD4 cell counts. The study clearly demonstrated that starting HIV treatment earlier reduces the risk of serious illnesses, AIDS and death. People who began HIV treatment earlier also had a better quality of life than people who waited.

Researchers have now analysed this data more closely to see if the general benefit also applies to two sub-groups.

Firstly, people who had a low viral load (below 3000 copies/ml) before taking treatment. This study also included a small number of people with a viral load below 50 copies/ml who might possibly be described as ‘elite controllers’. It’s sometimes asked whether individuals in this situation really need HIV treatment.

The researchers found that prompt initiation of HIV treatment was associated with favourable outcomes, including increases in CD4 cell count, sustained viral suppression and favourable changes in biomarkers indicating systemic inflammation. Treatment also almost eliminated the risk of onward HIV transmission. On the other hand, there was no difference in serious illnesses and deaths.

Looking specifically at the smaller group with a viral load below 50 copies/ml, a clear clinical benefit to starting treatment was not observed, but neither was there any evidence of harm. The researchers say that doctors may need to go ‘beyond the guidelines’ and make individualised treatment decisions in partnership with patients.

The second analysis concerns people who had only had HIV for six months or less when they joined the study. The researchers compared outcomes between this group and people who had had HIV for longer.

Promptly starting treatment produced the biggest boost in CD4 cell count for people with recent infection. They also had the greatest increase in CD4:CD8 ratio, indicating greater normalisation of immune function.

And looking at people who delayed treatment until their CD4 cell count dropped to 350 or below, the researchers found that this happened more quickly in those with recent infection, suggesting that without immediate treatment they are especially vulnerable to HIV disease progression.

This analysis suggests that immediate treatment is probably especially beneficial for people with recent HIV infection.

For more information, read NAM's factsheet 'Starting HIV treatment'.