Anxiety disorders and adherence to HAART

Background: Anxiety disorders are frequent in HIV patients, often associated with depression. Anxiety may pre-exist to the HIV infection, be related to its acquisition (unsafe sex, drug use) or develop after diagnosis (fear of death and stigma). HAART could induce anxiety while adherence can be reduced by psychological disorders. Very few studies analyzed relationship between adherence and anxiety. Aim of this study is to evaluate if adherence is related to anxiety. Methods: We analyzed anxiety in a group of HIV+ patients on HAART from over 6 months with the SELF RATING ANSIETY STATE SAS 054 test that explores sympathetic and post traumatic stress disorders symptoms (15 items) and the welfare status (5 items). Z score ≥ 45 points was considered diagnostic of anxiety. Adherence was assessed using a short form of self-administered Patient Medication Adherence Questionnaire (PMAQ7). Results: 153 patients were included into the study. Median age 45 (IQR 39-50) years, 73.2% males, 37.6% heterosexuals, 39.6% MSMs, 21.5% IVDUs. 52% CDC A, 22% CDC B, 26% CDC C. Median CD4 cell count 594 cells/μl (IQR 375-839), 78.8% had HIV RNA < 50 copies/ml. 73 subjects (47.7%) present a z score ≥ 45, diagnostic of anxiety disorders. 51.6% declared adherence to the treatment, 9.2% referred one or more missing dose during last week, 15% two-four weeks before the test, 24.2% more than 4 weeks before. When we analyzed all the patients, to be not adherent in the previous week, in the previous 4 weeks or at all was not related to the anxiety. When we stratified for gender, we evidenced that anxious male are not adherent (p< 0.01). Conclusions: Anxiety disorders are very common and could modify different patients´ life aspects. Capacity of adherence of male patients seems to be influenced by anxiety while other and different behavioural factors could modify female adherence.