"Mental illness and substance abuse appear to affect how well patients respond to HIV treatment," Dr. Brian Wells Pence from the Center for Health Policy, Duke University, Durham, North Carolina told Reuters Health. "Therefore, it is important to assess for and treat comorbid psychiatric conditions in HIV patients."

Dr. Pence and associates examined the relationship between psychiatric comorbidity and virologic and immunologic response among 198 patients initiating HAART. They report their findings in the February 1st issue of the Journal of Acquired Immune Deficiency Syndromes.

Patients with a higher predicted probability of having any mood, anxiety, or substance use disorder were more likely to demonstrate overall virologic failure and showed a trend toward delayed virologic suppression after initiation of HAART, the authors report.

Patients with the highest predicted probability of having a psychiatric or substance abuse disorder took about 41% longer to achieve virologic suppression and developed virologic failure twice as quickly as other patients, the results indicate.

The same trends were evident when depression, alcohol abuse or dependence, and drug abuse or dependence were considered separately, the researchers note.

"Although we hypothesize that reduced medication adherence may explain part or all of the observed association between psychiatric morbidity and clinical response to HAART, we were unable to test this hypothesis in the current study," the investigators add.

Dr. Pence suggested that "patients should be screened at entry into care and at least yearly thereafter."

"We are planning a randomized, controlled trial to investigate whether routine integration of depression screening and treatment into HIV care improves HIV medication adherence and clinical outcomes," Dr. Pence said.

J Acquir Immune Defic Syndr 2007;44:159-166.

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