Attention Deficit and Hyperactivity Disorder in HIV Infected Patients

Background: People living with HIV (PLWH) are more likely to lose attention, have concentration difficulties and a tendency to be more talkative than other patient populations. These may be associated with Attention Deficit and Hyperactivity Disorder (ADHD). The aim of this study was to investigate the presence of ADHD and other psychiatric disorders among PLWH and their effect on adherence to therapy.

Methods: PLHW who presented for care in three hospitals were recruited between 2012 and 2016. Study participants underwent a structured clinical interview for DSM-IV axis I personality disorders (SCID-I). Individuals who were not diagnosed with psychiatric disorders listed in the exclusion criteria were assessed using the 17-item Hamilton Depression Scale and underwent a semi-structured clinical interview for DSM-IV for ADHD. They also self-completed the Wender-Utah Rating Scale and the State-Trait Anxiety Inventory.

Results: Eighty-six cases were included; 21 (24.4%) were female and the mean age was 37.7±9.3 years. Thirteen (15.1%) cases were newly diagnosed. The average follow-up time was 3.7±4 years. Twenty-five (29.1%) cases were diagnosed with isolated ADHD. Twenty-six patients (30.2%) already had symptoms suggestive of a psychiatric disorder when recruited. Attention deficit and hyperactivity disorder was identified in 19.2% of cases with psychiatric symptoms compared to 33.3% of those without (p=0.209). Adherence problems to antiretroviral therapy were identified in 27 (31.4%) cases (40% among cases with ADHD and 28.8% among those without; p=0.321). Other psychiatric diagnoses included 57 (66.3%) cases with major depression, 13 (15%) with alcohol abuse, six (7%) with drug abuse, five (5.8%) with remission of bipolar disorder, five (5.8%) with antisocial personality disorder, three (3.5 %) with obsessive-compulsive disorder, three (3.5 %) with anxiety disorder, three (3.5%) with previous panic attack, two (2.3%) psychotic disorders and one (1.2%) mental limitation.

Conclusion: Major depression and ADHD were the two most common psychiatric disorders among PLWH. ADHD was present in a large percentage of PLWH independent of other psychiatric disorders. These results may be useful to overcome issues such as drug inadherence frequently encountered in HIV positive patients. Treatment of psychiatric disorders may increase patient compliance.