Untreated anxiety associated with worse viral suppression in people living with HIV

Among people living with HIV, viral suppression rates were similar between those with treated anxiety and those without anxiety, according to results from a Baltimore, Maryland, study. However, untreated moderate-to-severe anxiety was associated with worse viral suppression rates. Racial and gender disparities were also observed.

About This Study

“The anxiety care continuum and its association with viral suppression among persons with HIV” was published online on Aug. 1, 2024, in AIDS. The lead author is Lauren C. Zalla, Ph.D., of the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

Key Research Findings

This observational cohort study investigated anxiety, its treatment, and viral suppression in 1,967 people living with HIV in Baltimore, Maryland, from 2014 to 2023. All participants were in care at a single HIV clinic with co-located psychiatric care. Most participants were Black men (64% of participants assigned male at birth and 82% of participants Black). HIV seroconversion was likely due to intravenous drug use in 31% of participants.

Participants completed multiple surveys, with a total of 7,395 surveys analyzed. Seventy-six percent of these indicated minimal anxiety, and 8% of the surveys each reported mild, moderate, or severe anxiety symptoms. White women (3% of all participants) were most likely to report moderate to severe anxiety and Black men (51% of all participants) were most likely to report no anxiety at all.

Forty-eight percent of the 567 surveys indicating severe anxiety also reported depressive symptoms, compared to 2% of surveys noting minimal anxiety reporting depressive symptoms. Among participants with severe symptoms, 28% had been diagnosed with an anxiety disorder and 54% had been diagnosed with depression.

Viral suppression rates, defined as having a viral load measurement <200 copies/mL, were similar between participants without anxiety and those who received mental health treatment for anxiety (between 87%-89% of participants). However, in those with untreated moderate to severe anxiety, only 81% were virally suppressed. That rate dropped to 80% among Black men and to 77% among Black women who were not prescribed anti-anxiety medications.

Discussion Highlights and Implications for Practice

Study limitations reported included the observational and single-site nature, lack of information on long-term mental health trajectories vs. their treatment, and not considering changes in viral suppression.

The researchers noted that these findings indicated a “robust association between untreated moderate-severe anxiety and viral non-suppression.” They also said that their results show that screening for anxiety could identify barriers to viral suppression. Given the overlap between anxiety and depression, both conditions need to be addressed together.

The observed racial disparities are likely related experiences of discrimination, exposure to violence, and similar social determinants, the authors stated. They said that addressing these factors could narrow disparities.

By Barbara Jungwirth