By Marie Rosenthal, MS

Denmark might be one of the happiest places to live, but not necessarily for people living with HIV, who are three times more likely to develop psychiatric conditions and 10 times more likely to die by suicide within two years of a diagnosis than their noninfected peers, according to a study presented at ECCMID 2023: the European Congress of Clinical Microbiology & Infectious Diseases, held in Copenhagen, Denmark (abstract 2666).

“Our findings clearly highlight the serious mental health implications of being given a diagnosis of HIV and the importance of clinicians looking out for of symptoms of depression in this high-risk population,” said lead author Lars Omland, MD, PhD, an infectious disease specialist at Copenhagen University, who added that clinicians should care for mental health as well as physical illnesses.

The researchers looked for depression in Denmark’s national health register among 5,943 individuals diagnosed with HIV (25% women; average age at inclusion, 38 years) between 1995 and 2021. They compared their risk for depression with 59,430 sex- and age-matched controls from the general population. They also compared the risks between 5,807 siblings of people living with HIV and 82,411 siblings of controls. The researchers adjusted for a range of factors likely to influence the results.

Overall, people living with HIV had double the risk for depression and treatment with electroconvulsive therapy compared with controls; 1.5 times greater risk for antidepressant use; and 3.5 times increased risk for death by suicide. The risks were much higher within two years after a diagnosis.

In addition, the analysis found people living with HIV were more likely to use either inpatient or outpatient services at a psychiatric hospital before and after an HIV diagnosis. They also found 6.4% of people living with HIV used antidepressants, which was 1.2% more than controls two years before study inclusion.

Sibs Not Spared

Siblings of people living with HIV also faced an increased risk for the use of antidepressants and death by suicide compared with population controls, but rates were lower than for those with HIV, the researchers said.

“The higher risk for developing depression and suicide in both people living with HIV and their siblings is very troubling, and we need to dig deeper to understand the causes,” Dr. Omland said. “One potential explanation for the increased risk of depression and suicide among siblings of people living with HIV could be stress and stigma related to a loved one being diagnosed with a chronic disease.”

Although the study was large, it was observational, and the researchers said they could not rule out the possibility that other factors influenced the results, such as alcohol or drug use. They also said the results might not apply outside of Denmark.

SARS-CoV-2 or HIV?

In related news, people living with HIV performed worse on cognitive tests in the first four months following SARS-CoV-2 infection compared with those without HIV, but these differences appeared to be attributable to HIV but not to COVID-19 (abstract 3551), according to researchers from the Johns Hopkins University School of Medicine, Baltimore.

Neurocognitive dysfunction, such as brain fog, is commonly reported after COVID-19. Similarly, up to 50% of patients with HIV report HIV-associated neurocognitive disorder, and have difficulties in attention, concentration, decision making and memory. However, it is not known whether people living with HIV have different neurocognitive symptoms or sequelae after COVID-19 than those without HIV, the researchers said. 

The researchers studied 294 adults who were enrolled in the amfAR, The Foundation for AIDS Research–Johns Hopkins University COVID Recovery Study investigating the long-term effects of COVID-19 in people with and without HIV.

Between June 2021 and January 2023, 294 adults (average age, 47 years) were enrolled into four study arms: 

• participants who had SARS-CoV-2 infection for the first time within 30 days before enrollment with HIV (56 people living with HIV, arm 1) and without HIV (105, arm 2); and
• participants with no history of SARS-CoV-2 infection with HIV (66, arm 3) and without HIV (67, arm 4). 
  

More than 90% of the cohort were vaccinated against COVID-19 prior to enrollment.

All participants underwent a series of 11 cognitive assessments by telephone at one and four months after COVID-19 symptom onset (arms 1 and 2) and one and four months after enrollment for those who had never had COVID-19 (arms 3 and 4). Researchers then calculated age-standardized scores for all assessments as well as age-, sex- and education-standardized scores for verbal fluency.

Among respondents with a history of COVID-19, people living with HIV scored lower than those without HIV on general knowledge questions, verbal memory and verbal fluency at one month post–COVID-19, after controlling for age, sex, years of education and body mass index. The cognition test was also adjusted for COVID-19 vaccination, and verbal fluency tests also were adjusted for race, income and recreational drug use. The differences in verbal memory and category-cued verbal fluency persisted for least at four months post–COVID-19.

However, the researchers found no significant differences in any of the 11 cognitive assessments between those with and without a history of COVID-19 at one month post–infection or enrollment, respectively, which suggests that cognition differences were due to HIV and not COVID-19, they said. 

When examining people without HIV, the analyses found that respondents with a history of COVID-19 performed worse on processing speed than those who had never had COVID-19 at both one and four months. Respondents without HIV also scored lower on verbal memory and verbal fluency at one month post–COVID-19, but showed improvements by four months.

“Our findings underscore the importance for healthcare professionals to be vigilant to these longer-lasting neurological symptoms in people living with and without HIV who have had COVID-19,” said Alisha Dziarski, a medical student at Johns Hopkins.

None of the sources reported any relevant financial disclosures.