While HIV/AIDS has become a chronic, manageable illness for people with access to HIV medical care and treatment with antiretrovirals, there is ample evidence of an ongoing pandemic, with 36.9 million persons living with HIV, even though HIV and AIDS are entirely preventable. Symposium presenters are academics from the WPA HIV Psychiatry Section. They will underscore the importance of a comprehensive biopsychosociocultural approach to HIV/AIDS care and psychiatric care. Dr. Pereira will review advancements in HIV treatment and consequent increase in life expectancy. He will review challenges with current HIV treatment, including drug-drug interactions and neuropsychiatric side effects of ARVs. Dr. Sales will describe overlapping features between COVID-19 and HIV pandemic responses. He will review similarities and differences between long COVID syndrome and HIV associated neurocognitive disorder (HAND). He will address HIV stigma, the COVID antivaccination movement, and the risk of moral injury while treating the pandemic of the unvaccinated. Dr. Siste will present her research findings from a cross sectional study in Indonesia showing that lifetime suicidality in persons with HIV was associated with depressive and anxiety symptoms, non-marital status, CD4 count < 500 cells/μl, and efavirenz use. She will discuss relevant suicide prevention strategies. Dr. Thisayakorn will describe the development of an innovative collaborative care model between psychiatry and primary care for persons with HIV in Thailand that could be replicated in underserved areas. This symposium will provide useful guidance for psychiatrists, mental health professionals and trainees as they face ongoing challenges in working with persons with HIV.
Consultation-Liaison Psychiatry has evolved its neurobiological formulation with the rise of the HIV/AIDS pandemic. Ever since, there has been a robust integration of both inpatient and outpatient services to better serve highly complex cases of people living with HIV (PLWHIV), who develop unique syndemic manifestations.
In this presentation, we will review how lessons learned from the HIV/AIDS pandemic propelled a rapid organization and transition of healthcare systems to better serve patients suffering from COVID-19, as well as how the practice of consultation-liaison psychiatry evolved to address unique challenges faced by PLWHIV such as stigma, comorbid syndemic conditions, among others to provide integrated care for people living with long COVID-19 symptoms (also known as Post-Acute Sequelae of SARS CoV-2 infection, PASC).
BACKGROUND It is important to identify attributes of suicidal ideation among people living with HIV (PLHIV), so the prevention on mental health problems and HIV/AIDS medication can be optimized. However, only few studies discussing features of suicidal thoughts among PLHIV, including in Indonesia.
Suicidal ideation is common in PLHIV with psychosocial comorbidities. This study intends to identify suicidal ideation relation with other psychopathologies and determining its factors among Indonesian PLHIV.
METHODS Cross-sectional study was conducted to PLHIV aged 18-65 years old currently on antiretroviral therapy (ART). Demographic and SCL-90 questionnaires were done. Firth’s penalized logistic regression analysis was performed to identify association between variables.
RESULT 86 participants met the criteria, with median age of 35 years old and predominantly male (65.1%). Lifetime suicidal ideation was found among 20 participants (23.3%). Average SCL-90 T-score for depressive (M=60,75; SD=12; p = 0.000) and anxiety symptoms (M=57.9, SD=2.8, p=0.001) were significantly higher in suicidal ideation subjects. Bivariate analyses demonstrate lifetime suicidal ideation association with depressive and anxiety symptoms, unmarried, CD4 count <500 cells/μl, and efavirenz use. Multivariate analysis shown that increased SCL-90 depression score (AOR 1.16, 95%CI 4.5–123.6, p=0.000) and efavirenz (AOR 5.00, 95%CI 1.02–24.6, p=0.048) were significant factors to suicidal ideation.
CONCLUSION Suicidal ideation is significantly associated with depressive symptoms and efavirenz use. Early depression screening and efavirenz substitution are recommended for suicide prevention and enhancement of HIV/AIDS management.
KEYWORDS Suicidal Ideation, HIV/AIDS, Efavirenz, Depression, Anxiety