One Third of US HIV+ Mothers Have Psychiatric or Substance Disorders

One third of HIV-positive mothers in the US Pediatric HIVAIDS Cohort Study (PHACS) had a psychiatric or substance abuse disorder, but that rate did not differ significantly from prevalence in an HIV-negative comparison group. Fewer than 10% of HIV-positive mothers ever received treatment for these disorders.

In the United States a high proportion of HIV-positive women have low income, poor social support, and often poor access to medical care. As a result, many of them suffer from psychiatric and substance use disorders. To learn more about these disorders in HIV-infected mothers, researchers studied 1223 mothers in the PHACS group, comparing them with 128 HIV-negative mothers.

Results of the Client Diagnostic Questionnaire (CDQ) indicated that 35% of mothers screened positive for a psychiatric or substance abuse disorder when first tested, and rates did not differ between mothers with and without HIV.

Among HIV-positive mothers, statistical analysis adjusted for other risk factors linked younger age, single parenthood, and functional limitations to higher odds of any disorder, at the following adjusted odds ratios (aOR) (and 95% confidence intervals):

• Younger age: aOR 1.39 (95% CI 1.09 to 1.75)
• Single parenthood: aOR 1.35 (95% CI 1.08 to 1.68)
• Functional limitations: aOR 2.29 (95% CI 1.81 to 2.90)

In the HIV group, 689 mothers completed a follow-up CDQ to yield information on incident or persistent disorders. Among women without a psychiatric or substance use disorder at the initial visit, functional limitations almost doubled the odds of such a disorder developing during follow-up (aOR 1.92, 95% CI 1.10 to 3.30).

Of the 238 HIV-positive mothers who had a disorder at the first evaluation, disorders persisted in 145 (61%). Two factors were independently associated with higher odds of persistent disorders:

• Lower income: aOR 2.44 (95% CI 1.33 to 4.76)
• Functional limitations: aOR: 3.19 (95% CI 1.87 to 5.48)

Only 4.5% of women received treatment for any disorder at study entry, only 7% during follow-up, and only 5.5% at both entry and follow-up.

The investigators conclude that "psychiatric and substance use disorders remain significant comorbid conditions among HIV-infected mothers and require accessible evidence-informed treatment."

Source: Kathleen M. Malee, Claude A. Mellins, Yanling Huo, Katherine Tassiopoulos, Renee Smith, Patricia A. Sirois, Susannah M. Allison, Deborah Kacanek, Suad Kapetanovic, Paige L. Williams, Mitzie L. Grant, Daniel Marullo, Angela A. Aidala, for the Pediatric HIVAIDS Cohort Study (PHACS). Prevalence, incidence, and persistence of psychiatric and substance use disorders among mothers living with HIV. JAIDS. 2014; 65: 526-534.

Written by Mark Mascolini on behalf of the International AIDS Society