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Combination Antiretroviral Therapy and Improvements in Mental Health: Results From a Nationally Representative Sample of Persons Undergoing Care for HIV in the United States

Chan Kitty S.; Orlando, Maria; Joyce, Geoffrey; Gifford, Allen L.; Burnam, Audrey M.; Tucker, Joan S.; Sherbourne, Cathy D.
JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2003

Objective:To test whether mental health improvements observed in a nationally representative sample of 2466 HIV+ persons receiving care in the United States during the dissemination of combination antiretroviral therapy (ART) is a result of global optimism or directly related to treatment.

Analysis:Data were analyzed by means of a linear regression model of the change in psychiatric symptoms from baseline (January 1996-April 1997) to the first followup interview approximately 8 months later as a function of changes in CD4+ counts, opportunistic infection treatments, and HIV physical symptoms in the overall sample and separately in participants who maintained ART, initiated ART, never received ART, or transitioned to a less recommended regimen during the study period.

Results:The reduction in psychiatric symptoms was comparable across all treatment groups (p > .05), suggesting a global effect. In patients who initiated or maintained ART, fewer psychiatric symptoms were significantly related to higher CD4+ and fewer opportunistic infection treatments and HIV symptoms, however, suggesting a treatment effect.

Conclusion:ART appears to be responsible for both a treatment-specific and global improvement in the mental health of HIV+ patients, possibly through the promise of extended survival and a better quality of life.

Address corresponding and reprint requests to Kitty S. Chan, Health Program, RAND Corporation, 1700 Main Street, PO Box 2138, Santa Monica, CA 90407-2138. E-mail:

Manuscript received October 4, 2002; accepted January 30, 2003.

© 2003 Lippincott Williams & Wilkins, Inc.