Rates and Types of Psychiatric Disorders in Perinatally Human Immunodeficiency Virus-Infected Youth and Seroreverters

With the advent of antiretroviral therapy (ART), there has been a drastic reduction of perinatally transmitted HIV in the developed world in the last decade (Abrams, 2004). Unfortunately, these advances come late for a cohort of children born with HIV infection before widespread use of ART to prevent mother to child transmission who have had to contend with significant psychosocial, medical, and developmental challenges. In the United States (US), pediatric HIV has become an adolescent epidemic. As of June 2006, in New York City (NYC) where this study takes place, 64% of children living with perinatal HIV infection were older than 12 years (New York City Department Health and Mental Hygiene, 2007). Adolescence is a developmental stage in which psychiatric disorders if present are likely to emerge and a period characterized by experimentation with drug use (Havens & Mellins, 2008). Psychiatric illness and substance abuse have been linked to health risk behaviors including unsafe sex and non-adherence to medications. The emergence of psychiatric illness, drug use and sexual risk behavior can be detrimental to the health and well-being of HIV+ youths and may place others at risk for secondary HIV-transmission, creating a significant public health challenge. US clinical reports indicate substantive mental health problems in perinatally HIV-infected adolescents (Gaughan, et al., 2004; Havens & Mellins, 2008). However, there are few published studies examining psychiatric disorders, including substance abuse in this population and even fewer that define disorders in accordance with the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) of Mental Disorders system (American Psychiatric Association, 1994). A recent review of the literature revealed only eight studies that looked at DSM psychiatric disorders in HIV+ children and adolescents (Scharko, 2006). It is difficult to draw conclusions given that across studies sample sizes were small, assessment methods varied, youth ages ranged from 4-21 years, studies did not always distinguish mode of infection (perinatal vs. behaviorally acquired), and control groups were not always included. The role of pediatric HIV in influencing mental health and substance abuse is difficult to determine given the confluence of biomedical, genetic, and environmental factors that place this population at risk. The majority of perinatally infected adolescents experienced years of less than optimal ART that may have resulted in poorly controlled HIV. HIV directly impacts the central nervous system (CNS), affecting neurocognitive function and mood regulation (Brouwers, Belman & Epstein, 1991; Castellon et al., 2006). Given the epidemiology of HIV in US women, the majority of perinatally HIV-infected and HIV-exposed youths live in the inner-city, confronted by stress, poverty, trauma and disrupted family attachments, all of which have been associated with poor behavioral outcomes in other populations (Havens & Mellins, 2008). They are also at risk for mental health and substance use problems for genetic and environmental reasons given the high prevalence of substance abuse and psychiatric disorders in the birth mothers of HIV+ youth, particularly this older cohort (Havens & Mellins, 2008). In summary, there are many risk factors for mental health problems in perinatally-infected youths. Few studies target this population and use appropriate methods to examine the association of HIV with behavioral outcomes. Understanding the types of mental health and substance abuse disorders, as well as the potential role of HIV disease and other familial factors is a critical step for developing preventive interventions for the growing population of perinatally-infected adolescents. Using baseline data from Project CASAH (Child and Adolescent Self-Awareness and Health), one of the largest US based studies of psychosocial determinants of behavior in a sample composed of both perinatally HIV-infected (HIV+) and perinatally HIV-exposed, but uninfected (seroreverters; HIV-) youths with similar age and demographic characteristics, this study examines: 1) rates and types of psychiatric and substance abuse disorders in HIV+ 9-16 year old youths; and 2) the association between HIV infection and these mental health outcomes by comparing HIV+ youths to seroreverters. Seroreverters are an ideal comparison group because, with the exception of child HIV status, sociodemographic and family characteristics, including perinatal exposure to HIV are for the most part very similar, providing an opportunity to explore the unique contribution of HIV infection to mental health outcomes.