HIV Mental Health, Substance Risk During the Pandemic

A conversation in consideration of the high-risk psychosocial comorbidities the aging HIV population may face through COVID-19.

A continually novel element in long-term HIV care is the aging population; breakthrough antiretroviral therapy (ART) and other viral-suppressing agents available in standard practice have assured patients a longer lifespan. Therefore, HIV/AIDS clinicians are constantly encountering older and older patients with the chronic disease.

With that positive development is the caveat which burdens most patients with chronic disease, Ellen Eaton, MD, explained to Contagion.

“Our population is aging, and as they do, they collect comorbidities just like our HIV-negative population,” she said. “We see depression, anxiety, and other things like diabetes and hypertension.”

And with the introduction of a possibly deadly, definitely life-altering virus pandemic, those comorbidity risks in the high-risk HIV population are even more greatly psychosocial: depression, suicide ideation and substance abuse disorder, among others.

In an interview with Contagion during IDWeek 2021, Eaton, from the University of Alabama at Birmingham, discussed her presentation topic at the annual infectious disease meeting: the multifactorial burdens of people living with HIV during the COVID-19 pandemic.

As Eaton explained, the unique population is facing more barriers to treatment, a greater rate of adopted unhealthy behaviors and addictions due to the stressors of the pandemic—and all of it is accumulating in risk of worsened control of their HIV. On top of it all, many HIV clinics have been required to work remotely during outbreaks, compromising direct patient access to care.

“It’s really the perfect storm for more HIV transmissions,” Eaton said. “It’s the perfect storm for things like suicide and overdose.”

Eaton also touched on some positive developments for the HIV community during COVID-19: telemedicine has been embraced by a portion of patients, and relaxed policies for opioid use disorder have enabled more beneficial prescribing for at-risk persons.

But it’s both the burdens and positives which clinicians must take away from the pandemic to better inform response to the next great societal issue that could uniquely impact the HIV community.

“What we know is that we’ll probably see more ripples and waves of COVID-19—and if not COVID, we know that every few years or so, we are subject to different public health issues, societal unrest, other issues that may disrupt our traditional brick-and-mortar clinics,” Eaton said.