Acceso usuarios
Jessica Mejía Castrejón, Tavata Bejarano Colina, Nancy Patricia Caballero Suárez, Vania Barrientos Casarrubias, Ester Gutiérrez Velilla
Parte de la acción coordinada para la atención de personas que viven con VIH (PVVIH) incluye servicios de salud mental. Esto se debe a la alta prevalencia de trastornos mentales y su gran impacto en la salud y calidad de vida de los pacientes, así como en la salud pública, como puede observarse en los casos con trastornos de ansiedad.
El objetivo del presente documento es sintetizar la información básica y actualizada sobre la prevalencia, las características clínicas, la etiología, así como el diagnóstico e intervenciones psicológicas de los trastornos de ansiedad en PVVIH.
Se realizó una revisión narrativa según los criterios de la escala SANRA (por sus siglas en inglés, Scale for the Assessment of Narrative Review Articles). Se seleccionaron artículos en inglés, publicados entre el 1 de julio de 2011 y el 1 de julio de 2021 en PubMed con las palabras clave “HIV", "AIDS", "PLWHIV" y "anxiety".
La prevalencia de ansiedad entre PVVIH puede alcanzar un 27.9 %. Respecto a la etiología, existen teorías que consideran aspectos biológicos, psicológicos, genéticos, sociales. Además, se debe tomar en cuenta la relación bidireccional entre el VIH y la ansiedad. El proceso diagnóstico de los trastornos de ansiedad puede incluir el uso de escalas o sistemas de clasificación, pero hay que considerar los diagnósticos diferenciales ya que las PVVIH pueden tener distintas comorbilidades o tomar medicamentos que pueden generar síntomas ansiosos. Actualmente el tratamiento psicológico más eficaz para la ansiedad es la terapia cognitivo-conductual, aunque hay otras intervenciones que se están estudiando con resultados benéficos; sin embargo, estas se deben adaptar a distintos escenarios de atención y que incluyen intervenciones comunitarias para reducir el estigma.
Comprehensive care for people living with HIV (PLWH) includes mental health care due to the high prevalence of mental disorders and their impact on personal and public health levels. Among the most prevalent mental disorders in PLWH are anxiety disorders, which are associated with inadequate antiretroviral treatment adherence, increased substance use, risky sexual behaviors, increased risk of depression and suicide, more emergency visits and hospitalizations, and deterioration in the quality of life. However, despite the great impact of anxiety in this population, it is sometimes not identified, delaying psychological and/or psychiatric care, so it is important to disseminate the most important aspects of anxiety disorders.
The objective was to synthesize basic and updated information on anxiety disorders in PLWH, as well as their prevalence, clinical characteristics, etiology, diagnosis and psychological treatment.
A narrative review was carried out following the criteria of the Scale for the Assessment of Narrative Review Articles (SANRA) to ensure its quality. Articles written in English, published between July 1, 2011, and July 1, 2021, in PubMed with the keywords "HIV", "AIDS", "PLWHIV" and "anxiety" were selected.
The prevalence of anxiety among PLWH is high, reaching up to 27.9 %, although it varies depending on the specific diagnosis and the population studied. Anxiety disorders are characterized by the presence of psychological and physical symptoms whose presentation is usually excessive, disproportionate, and persistent, causing clinically significant discomfort or deterioration in social, academic, occupational, or other important areas of the individual's functioning. Regarding the etiology, some theories consider biological, psychological, genetic, and social aspects, and in the case of HIV infection, the bidirectional relationship must be considered, where the infection increases the risk of developing anxiety and anxiety increases the risk of HIV complications. The diagnostic may include the detection of symptoms through the psychological test or of a diagnostic classification system such as CIE-10 or DSM-5, but the presence of diseases and the consumption of medications must be considered since these could also generate symptoms of anxiety. In general, it is suggested that as part of comprehensive care, a screening be carried out within three months after HIV diagnosis and annually thereafter. Currently, the most effective psychological treatment for anxiety is cognitive behavioral therapy; it is a brief treatment and can be administered individually or in a group. In addition, other interventions are being studied with beneficial results for dealing with anxiety, however, the interventions must be adapted to different care scenarios and also consider community interventions to reduce stigma.
Mental health care for PLWH, specifically the identification and care of anxiety disorders, should be integrated into the continuum of specialized HIV care for the timely detection and treatment of possible psychological needs of the patient. Because mental health problems are related to inadequate adherence to antiretroviral treatment, promoting adherence should be a basic component within any type of psychological intervention provided to this population. Mental health interventions, in addition to community interventions, can contribute to the continuum of care and achieve the goal that 95% of people with virologic control have a good health-related quality of life.
