Background
Single cohort UK data suggests an increased lifetime prevalence of psychosis in young people living with perinatally acquired HIV (YPaHIV) compared to age matched peers in the general population (0.5-1.0%), echoed by US data. This is thought to be due to lifelong exposure to a neurotropic virus, neuroinflammation during brain development, and greater experience of adverse life events such as parental death. We examine clinical and psychosocial characteristics associated with psychosis in YPaHIV.
Methods
Retrospective case note review of all YPaHIV ≥18years engaged in care at three London youth HIV clinics (n=377) from first attendance to 01/04/2024. We assessed impact of gender, ethnicity, birthplace, prior CDC-C diagnoses, learning disability, parental death, family history of mental health disorders (FHxMHD), and cannabis use on developing psychosis using a multivariate logistic regression model.
Results
27/377 (7.2%) YPaHIV experienced psychosis (YPaHIVP), median age at first episode psychosis (FEP) 21 (IQR 17 – 25) years: current median age 29 (IQR 25 – 31) years, 48.1% male, 81.5% Black, 61.5% born abroad. Age, gender, ethnicity, and birthplace were comparable to YPaHIV without psychosis (YPaHIVwP). Factors significantly associated with psychosis were prior CDC-C diagnoses (OR 3.51, 95% CI 1.17 – 10.49, P=.03), parental bereavement (OR 6.47, 95% CI 1.97 – 21.20, P=.002), cannabis use (OR 7.13, 95% CI 2.45 – 20.78, P<.001) and FHxMHD (OR 23.46, 95% CI 5.51 – 99.82, P<.001). 68.2% YPaHIVwP had VL<200 copies/mL at FEP, in 21/27 (77.8%) no organic cause was identified. All required admission. Median time from FEP to latest follow up (LFU) was 84 (IQR 36 – 108) months; 20/27 (74.1%) had recurrent psychosis, 66.7% remained on antipsychotics, median length of community mental health follow up was 40 (IQR 27 – 81) months. At LFU 85% of YPaHIVP had VL<200 copies/mL compared to 88.6% of YPaHIVwP (P=.06). 33.3% of YPaHIVP reported self-harm or suicidality compared to 3.7% YPaHIVwP (χ² 22.20, P<.001).
Conclusions
In this multi-centre cohort of YPaHIV, psychosis prevalence was 7 times greater than the general age-matched UK population and was associated with high levels of self-harm and suicidality. Clinicians should be aware of increased susceptibility of psychosis in YPaHIV, particularly those with prior CDC-C diagnoses, cannabis use, parental bereavement and FHxMHD. It is imperative to integrate mental health services into HIV care particularly during the vulnerable period of transition.