Study of HIV-Infected Youth: Antiretroviral Therapy not Associated with Severity of Psychiatric Disorders
Dr. Sharon Nachman Reports Findings in Archives of Pediatrics & Adolescent Medicine
|Dr. Sharon Nachman|
STONY BROOK, N.Y., February 6,
2012 – A study of more than 300 children and adolescents with human
immunodeficiency virus (HIV) revealed no association between specific
antiretroviral therapy and the severity of psychiatric disorders. In
“Human Immunodeficiency Virus Disease Severity, Psychiatric Symptoms,
and Functional Outcomes in Perinatally Infected Youth,” Principal
Investigator Sharon Nachman, M.D., of Stony Brook School of Medicine,
and colleagues detail this finding and others in the Online First
edition of Archives of Pediatrics & Adult Medicine.
Children living with HIV often develop psychiatric and behavioral
disorders. A major concern for health professionals is if the severity
of HIV illness or use of specific antiretroviral therapy regimens put
these children at an increased risk for mental health problems.
“Our study indicates that specific antiretroviral therapy and severity
of HIV infection in children and adolescents are not necessarily
associated with the level of mental health problems experienced by these
patients, which counters the conventional thinking about the
relationship between HIV and the development of psychiatric disorders,”
says Dr. Nachman, Associate Dean for Research, and Professor of
Pediatrics at Stony Brook School of Medicine.
Dr. Nachman and colleagues completed a cross-sectional analysis of entry
data from a two-year study of 319 participants between 6 and 17 years
of age who were HIV infected around the time of their birth. All were
enrolled in the International Maternal Pediatrics Adolescent AIDS
Clinical Trials Group (IMPAACT) study number 1055. One-third of the
participants met the criteria for at least one of seven targeted
psychiatric disorders, such as depression and attention deficit
The researchers looked at each individual’s HIV severity markers prior
to and during the study, antiretroviral regimens, and severity of
psychiatric symptoms. They defined HIV illness by CD4 (cells that fight
off infection) percentage, viral load, or a past Centers for Disease
Control AIDS defining illness.
Dr. Nachman says some key findings include: Low CD4 percentage or high
viral load prior to the study did not link directly to any psychiatric
illness; current CD4 percentage or viral load did not predict
psychiatric illness or social and academic functioning; specific
antiretroviral therapy was not associated with any social or academic
function problems; pre-study high viral load and low CD4 percentage did
help predict which children had poorer social and academic functioning.
The researchers point out that in their analysis of HIV disease
variables and psychiatric symptoms, it is important to “emphasize that
findings were variable, mixed, and at times counterintuitive.”
For example, they note that a lower entry CD4 percentage was associated
with less severe depression, but a higher entry viral load was
associated with more severe depression.
“Overall, our findings are an indication that clearly other factors are
at play that are associated with or contributing to patients’
psychiatric and behavioral problems, which appear independent from their
HIV status or antiretroviral regimens,” explains Dr. Nachman.
She believes that future studies should examine other factors that may
be associated with severity of psychiatric symptoms in children and
adolescents with HIV, such as family environment.
The study was supported by the Statistical and Data Analysis Center at
the Harvard School of Public Health under the National Institute of
Allergy and Infectious Diseases cooperative agreements with the
Pediatric AIDS Clinical Trials Group and with the IMPAACT Group.
Study co-authors include: Miriam Chernoff, Ph.D., and Paige Williams,
Ph.D., Center for Biostatistics in AIDS Research, Harvard School of
Public Health; Janice Hodge, R.N.; Frontier Science and Technology
Research Foundation; Jerry Heston, M.D., Child and Adolescent Psychiatry
Associates, and St. Jude Children’s Research Hospital in Tennessee; and
Kenneth D. Gadow, M.D., Department of Psychiatry and Behavioral
Science, Stony Brook School of Medicine.