Study: HIV Prevalence in Patients With Serious Mental Illness 4 Times Higher Than the General Population

A large epidemiologic study in Baltimore and Philadelphia shows that patients with mental illness are 4 times more likely to have HIV infection than the general population. Results of this study reveal a need for routine HIV screening in mental health facilities.

A recent study of HIV infection in mental health settings has revealed a higher than expected prevalence of the disease in patients with serious mental illnesses. Previous studies of HIV prevalence in patients with mental health disorders were conducted in small samples and resulted in divergent estimates ranging from 1% to 23%.

In this large study, investigators measured the prevalence of HIV infection among patients receiving treatment for mental illness in Philadelphia and Baltimore between January 2009 and August 2011. Of 1061 patients who received testing, including confirmatory tests with Western blot laboratory testing, 4.8% of patients had a positive result for HIV infection.

This rate of HIV infection among those with serious mental illness was approximately 4 times higher than the prevalence observed in the general population, which was 1.3% in Philadelphia and 1.4% in Baltimore.

Among those tested, patients with HIV were more likely to be middle aged (40 to 49 years) or over 50 years of age. HIV infection was also more common among persons of African descent, among the homeless, among patients coinfected with hepatitis c virus, and among patients who had engaged in same-gender sexual relations. The likelihood of HIV infection was also positively correlated with more severe mental illness.

Many of the patients with HIV were already aware of their seropositive status. In Philadelphia, 87.5% of patients with a positive test result for HIV had prior knowledge of their infection. In Baltimore, 65.4% of patients with HIV were previously aware of their infection.

The results of this study indicate a gap in care for many patients with serious mental illness. Current guidelines from the Centers for Disease Control (CDC) do not specifically recommend HIV screening in patients with serious mental illness. However, the CDC guidelines do recommend routine counseling and testing among populations with a 1% or greater prevalence of HIV infection.

Based on the CDC guidelines and the 4.8% incidence of HIV infection measured in this large epidemiologic study, mental health care centers in urban areas should adopt routine testing procedures for patients with HIV.

References:

• Blank MB, Himelhoch SS, Balaji AB, et al. A Multisite Study of the Prevalence of HIV With Rapid Testing in Mental Health Settings. Am J Public Health. 2014.
• Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006.