HIV / STI
The anxiety care continuum and its clinical relevance for people living with HIV Lauren Zalla* Lauren Zalla Heidi Hutton Anthony Fojo Oluwaseun Falade-Nwulia LaQuita Snow Jeanne Keruly Richard Moore Catherine Lesko
Background: Anxiety is prevalent among people with HIV, but we know little about how it affects viral suppression (VS). We aimed to examine the anxiety care continuum and its association with VS in a large urban HIV clinic in the United States.
Methods: Johns Hopkins HIV Clinical Cohort participants contributed clinical and patient-reported outcome data from 2014-2023. Anxiety symptom severity was self-reported using standard scales (GAD-7 and PHQ-PD). We defined anxiety care continuum stages as: no anxiety (no anxiety symptoms or diagnosis); untreated anxiety (symptoms or diagnosis but no treatment); and treated anxiety (prescribed an anti-anxiety medication and/or engaged in mental health care). We fit generalized logit models to estimate crude and adjusted associations with the six-month probability of VS. We stratified models by sex and race/ethnicity (non-Hispanic White, non-Hispanic Black) and adjusted for age, years in care, and depressive symptoms using augmented inverse probability weights. We accounted for missing data using multiple imputation and estimated nonparametric bootstrap-based 95% confidence intervals (CI).
Results: Of 7,395 surveys from 1,967 patients, 46% were receiving anxiety treatment and 24% reported anxiety symptoms. Patients with untreated mild anxiety had a similar probability of VS as those with no anxiety (absolute difference: -0.4%; 95% CI: -3.7, 3.0). Those with untreated moderate-severe anxiety had 6.7% lower probability of VS (95% CI: -9.5, -3.9). Treated patients reporting moderate-severe anxiety had a 2.3% lower probability of VS than those with no anxiety (95% CI: -4.8, 0.3). In adjusted models, untreated moderate-to-severe anxiety remained associated with reduced VS among Black men (absolute difference: -3%; 95% CI: -7.5, 1.5), Black women (-2.9; -8.6, 2.7), and White men (-18.9; -28, -9.8).
Conclusion: Moderate-severe anxiety, especially when left untreated, may contribute to poor VS among people with HIV.
