• Science Update
Youths who were exposed to HIV before birth, especially those who were born HIV positive, have a high chance of developing psychiatric disorders, according to an NIMH-funded study published online ahead of print February 27, 2009, in the Journal of Child Psychology and Psychiatry.Background
The use of antiretroviral therapy (ART) has dramatically reduced the transmission of HIV during pregnancy, resulting in very low rates of new HIV infections among infants born in the United States. The advent of ART has also allowed children born with HIV to live longer and healthier lives. As a result, a large number of HIV+ youth are now reaching adolescence, a time when psychiatric disorders are likely to emerge and risky behaviors become more common.
Claude Ann Mellins, Ph.D., of the New York State Psychiatric Institute and Columbia University, and colleagues examined the prevalence of psychiatric disorders in 340 children in New York City, ages 9 to 16, who had been exposed to HIV before birth. Of these children, 206 were HIV+ and 134 were HIV negative (HIV-). Both the children and primary caregivers were interviewed for this study.Results of the Study
The researchers found that 61 percent of HIV+ and 49 percent of HIV- youths met criteria for a psychiatric disorder, most commonly an anxiety disorder. About 25 percent of participants met criteria for a behavioral disorder like attention deficit hyperactivity disorder (ADHD) or conduct disorder, with more HIV+ youths having ADHD than HIV- youths. About 7 percent of youths met criteria for a mood disorder such as depression, and 4 percent met criteria for a substance abuse disorder. Among those who met criteria for any mental disorder, about 33 percent had multiple disorders, with no differences between HIV+ and HIV- youths.Significance
The data show that, whether born HIV+ or not, youth exposed to HIV while in the womb are at high risk for mental disorders. And because psychiatric disorders often are associated with risky behavior, the authors suggest that these young people are more at risk for substance abuse, sexually transmitted diseases, pregnancy, and the spread of HIV. The researchers note that interventions have been developed to reduce mental health problems and risky behavior among HIV+ adults, but few have been developed for youth. They suggest that similar interventions targeting youth who were exposed to or infected by the virus before birth are sorely needed.What's Next
Larger, long-term studies are needed to determine how family characteristics, such as the health of the birth mother or whether caregivers have psychiatric disorders themselves, may affect outcomes among children born to women living with HIV. In addition, research is needed to determine how ART medications and psychiatric medications may affect one another as well as how it affects youth outcomes. Finally, clinicians should focus not only on treating the physical health of HIV-infected or HIV-exposed youths but also be aware of and attend to their mental health needs.
Mellins CA, Brackis-Cott E, Leu CS, Elkington KS, Dolezal C, Wiznia A, McKay M, Bamji M, Abrams EJ. Rates and types of psychiatric disorders in perinatally human HIV-infected youth and seroreverters. Journal of Child Psychology and Psychiatry. Online ahead of print Feb. 27, 2009.