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HIV; Vertical Transmission; Mental Health; Psychosocial Factors

Introduction

Successful implementation of programs to prevent mother-tochild transmission has significantly reduced the incidence of vertical HIV transmission in countries where Anti-Retroviral Therapy (ART) is available, and the age of Perinatal HIV-Infected Persons (PHIV) has increased. Most of his PHIV patients born in the 1990s are now adults and have been transferred to adult wards. These patients are at risk for HIV infection and disease related to his ART toxicity, and suffers from the associated social stigma and psychosocial effects of his HIV. A PHIV patient often experiences a complex socioeconomic situation combined with frequent Adverse Childhood Experiences (ACEs), which can adversely affect mental health and his HIV-related outcomes. PHIV-infected adolescents and young adults are more likely to be diagnosed with MH compared to the general population, which has a significant impact on Health-Related Quality of Life (HRQoL). Despite the increasing prevalence of MH problems in PHIV patients, data from various cohorts suggest that MH problems are undertreated. The inclusion of his HRQoL in his fourth goal of the Joint United Nations HIV/AIDS Program (UNAIDS) 90-90-90 has drawn attention to the mental health treatment gap. PSRF prevalence and access to specific care in his PHIV patient cohort in Spain to better understand his MH treatment gaps in PHIV patients and identify treatment priorities [1, 2].

Materials and Methods

A cross-sectional study was conducted at a public tertiary hospital in Madrid, Spain. Subjects included all PHIV patients followed in December 2018, regardless of age, including those treated in pediatric outpatient clinics and those already referred to adult care or the Pediatric Cohort of HIV Patients Transferred to Adult Care (FARO Project). Epidemiological, clinical, immunovirological, and therapeutic-related data were collected as part of the CoRISpe-FARO project. Since 2008, CoRISpe has collected prospective epidemiological, clinical, immunological, virological, analytical and antiretroviral data from HIV-infected children and adolescents in follow-up studies in children’s hospitals in Spain. We will enroll these patients in her FARO transition cohort after transfer to the adult ward and continue prospective followup [3].

MH-related variables include MH referral and diagnosis, management and treatment of mood and/or behavioral disorders, MH-related hospitalization, etc. To obtain these interesting variables, we reviewed the participants’ medical records and conducted semistructured interviews with all physicians involved in the participants’ clinical care, including physicians, nurses, and psychologists. . . We collected all available data, whether determined by the patient, family, or healthcare provider. Variables described in the literature as Psychosocial Risk Factors (PSRFs), some of which are considered ACEs, will be assessed simultaneously and include:

Family discord (parents separated or divorced), loss of parents, placement in family, placement in foster care, and experience of violence (domestic violence, bullying). Data on drug use and school performance were also collected. Adherence questions were collected retrospectively from the treating physician’s medical records. Viral suppression was defined as viral load < 50 copies/ml [4, 5].

Discussion

In this study investigating MH in a cohort of PHIV patients already admitted to adult wards, the prevalence of MH problems was high (41.7%). PSRF and ACE were common in this population and associated with MH problems. Referral to MH wards was rare (23.6%), even in patients with signs and symptoms, and among patients with MH problems receiving psychiatric diagnosis and treatment, he was 3.2% and he was 4. was less than a quarter. Our study points to a major gap in the treatment of MH in patients living with HIV. Addressing the social determinants of health and incorporating MH and psychological support into the care of this unique population from childhood through adulthood is critical to improving patient quality of life. MH in children and adolescents is a global problem. According to a recent United Nations report on pediatric MH, more than 13% of adolescents aged 10-19 worldwide have a mental disorder. In Western countries (and even more so after the COVID-19 pandemic), their numbers are rising exponentially [6].

Compared with the general population, children, adolescents and young adults living with her PHIV in a variety of settings are and young adults living with her PHIV in a variety of settings are more likely to have MH problems. Our data are consistent with these findings, showing prevalence of psychiatric disorders as high as 50% in certain studies. The prevalence of PSRF and ACE was also high, with 32% of patients having at least one and 4% having four or more. This is concerning, but our ACE prevalence figures are lower than those found in other studies, including studies of people living with HIV and the general population, with approximately 60% have at least 1 ACE and more than 10% have 4 or more ACEs. More ACEs have an ACE prevalence of 4 or more. Ace In our study, data on PSRF were collected retrospectively. Due to the retrospective nature of the study, no specific questionnaire was administered. Therefore, his PSRF and ACE contributions in this series can be underestimated. Visiting children in other families helps children to have a comprehensive picture of the social and family situation. Most pediatricians include information about the attending physician in the medical record. However, studies show that while most children with ACE take years to identify with themselves, some do not. As shown in previous studies, PSRF was associated with adherence problems and MH problems [7].

Our study, using a broad definition of MH that included all documented signs and symptoms, as well as definitive diagnosis and treatment, found that a high proportion of patients with MH had pediatric follow-up. In our series, MH disorders were identified by patients, their families, and/or health care providers. Subjective perceptions of MH disorders are determined by patients, their families, and/or health care providers. Subjective perceptions of MH disorders may be influenced by adult-child relationships and power imbalances, including elements of labeling and stereotypes. Additionally, our series appeared to lag significantly in transitioning from pediatric to adult care. At the time of their most recent visit, patients receiving pediatric care had a median age of 16 years (IQR, 11-24), and 69% of them were 15 years of age or older. Aiming to promote patient autonomy, achieve full adherence, and achieve viral suppression before to the transfer, studies addressing the transition have shown that difficult patients and those with adherence issues tend to be followed-up for longer in pediatrics [8].

When they enter adolescence and switch from pediatric to adult care, patients with chronic disorders identified as children go through a difficult time. Studies on a range of chronic illnesses have demonstrated how switching from a well-established, more individualized, youthfriendly outpatient model to a system that presumes patient autonomy may have a negative impact on treatment adherence and the connection to care. For youth living with HIV who are transitioning to adult care, the majority of recommendations call for an individualized strategy and the determination of the ideal timing based on clinical stability and patient autonomy rather than chronological age. Young persons with PHIV frequently wait until they are older before switching as a result. When comparing the prevalence of MH issues in pediatric and adult hospitals, this fact might help to explain the discrepancy [9].

Conclusion

The retrospective design included neither systematic psychological assessment nor active data collection on social determinants of health. This study had a small sample size and significant patient heterogeneity. An important limitation is that it encompasses the broad definition of MH, rather than being limited to cases diagnosed after appropriate MH assessment, based on the clinical judgment of the treating physician. However, mental health diagnosis is complex, follow-up is often delayed, and a more restrictive definition may compromise our ability to detect mild and moderate MH-related problems. Larger prospective studies are needed to determine the optimal strategy for dealing with this population. As we unravel the complex interplay between MH, HIV, ART, comorbidities, ACE, and social determinants of health, our findings suggest that health care systems are routinely involved in the management of chronic diseases such as HIV infection suggests that it faces challenges. It suggests the need to integrate psychological assessment and support into clinical practice. - Patients are at risk from an early age, providing an interdisciplinary approach to addressing medical and psychological issues, treatment adherence, and social determinants of health. To improve the quality of life for people living with HIV, the treatment gap associated with MH must be closed [10].

Acknowledgement

None

Conflict of Interest

None

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