“HIV infection is no long a death sentence. With that comes a few complications.”
HIV Chronic Disease Complications
Up until the advent of advanced combination treatments for HIV infection (Protease Inhibitors) in 1996, infected individuals experienced a fast progressing and fatal disease process. HIV is now considered a chronic disease to be managed, much like living with diabetes (Lancet, 2013).
There are a number of complications that HIV infected individuals face as part of the chronic disease management process. While the focus of this article is on depression, it is important to first understand a wider array of challenges faced by those living with HIV. Complications might include:
- Chronic Inflammation – A process where the normal inflammatory response to physical trauma persists even after the traumatic event, thus causing damage to healthy cells. Chronic inflammation throughout the body is common among those living with HIV. Effects are widespread that may include liver, kidney, and the cardiovascular disease.
- AVR Toxicity – A collection of various side effects associated with ARV medications – Idiopathic with some side effects considered life threatening.
- Neuropathy – Peripheral Neuropathy is often seen in the extremities (legs). It is an indication of damage to nerves, experienced as chronic itching and/or tingling. It is common in those with diabetes, alcoholism, and HIV.
- Anemia – A complication seen in those with poorly managed HIV infection – Associated with blood loss from Kaposi Sarcoma along the intestine, and cytomegalovirus infection in the gastrointestinal tract.
- Osteoporosis – It is unclear why, but Osteoporosis is frequently seen in individuals living with HIV, especially with age.
- Clinical Depression and Anxiety Disorder – Clinical Depression is seen in about 22% of those living with HIV. It is understood that this population statistic is higher among those with co-morbid substance misuse problems.
Depression Is Often Missed
With roughly a quarter of all HIV infected individuals living with depression, it should go without saying that treatment planning must consider mental health complications. This is often missed during the medication induction phase and stabilization. It takes several months for CD4 levels to increase to a range considered safe, depending on when treatment was initially started.
Symptoms overlooked include feeling of guilt, sleep disturbance, hopelessness and negativism, feeling sluggish, decreased sex drive, anhedonia, and suicidal thoughts. Each individual presents with a different combination of this collection of indicators. The most important indicator is the individual’s perception of being depressed. If you don’t ask in an intake screening, it will likely not be disclosed.
Six Approaches For Emotional Wellbeing – A Behavioural Medicine Perspective
We have developed five concepts designed to improve emotional wellbeing for those living with HIV. It is assumed that medical treatment and counselling have been initiated as part of a holistic biopsychosocial treatment approach. While informed by a broader behavioural medicine perspective, we believe the following concepts are helpful tools designed to augment your treatment journey.
1 – Believe that You Are Not Defined By Your Disease: From the time of initial diagnosis of HIV infection, to stabilization of care and treatment regime, it is easy to create a sense of self around your HIV status. This is particularly true when stigma is involved. Everyone goes through a period of time defining themselves by the disease label itself. Many never let that go. It is critical to create definitions of the self by all parts of who you are and what you do. Do you enjoy photography? Are you a runner? Does your partner consider you to be a good husband or wife? You are all those things in life, and more.
2 – Understand that Life Does Not End with Your Disease: Initially, living with chronic disease creates a sense of, ‘personal ending.’ You believe that you have been robbed of your longevity, thus building a persistent belief that life has no future, and thus no purpose. This style of thinking is seen in those with mood disorders. Hopelessness is eventually the consequence.
Instead, look past the potential complications of HIV infection. Chronic is the opposite of ending. With treatment adherence, your life is destined to be full of all the gifts available to others. Step out and embrace it.
3 – Manage Depression with a Focus On Prevention: Along the way, it is easy to get complacent about your mood. Prevention is key, rather than waiting for symptoms to emerge. Prevention over reaction predicts better mood and disease management into the future.
For instance, creating a routine to follow each day predicts improved engagement doing the things we love and time spent with others. The opposite is social isolation. If we wait, only later noticing social avoidance, it is difficult to jump start into a healthier approach.
4 – Dive Into the Sensual: Do you spend a ton of time locked inside your head? Being fastidious with prevention management as someone living with HIV can feel exhausting. Spending time doing purely sense based activities is proactive self-care and depression management. One example is using a deprivation chamber, or “floating.”
5 – Join a Support Group and Make Friends: HIV infection status and our reaction to the diagnosis, is complicated by social stigma. Being around others that have been newly diagnosed or living many years with the disease, provides perspective. You will find some with similar challenges, and others very different compared to yours. This has enormous therapeutic value – You learn that you are not alone, and that others have it better, or worse, than you. You then learn to provide support in the same way you need it yourself.
A Final Note
We hope that you find the five conceptual perspectives above useful in navigating the mood challenges associated with chronic disease. Depression is often overlooked because the physical symptoms of HIV infection trump mental health concerns. At Finding My Psych, we believe that any holistic biopsychosocial approach to care should consider all aspects of the care journey. If you want more information about our most recommend approach to depression management, check out our two part podcast series on the CHANGES model.
What do you think? Is there a sixth, or even seventh item you would add? Please be sure to drop us an email with your ideas. Or, if you are shy, feel free to contact us with your suggestion through our contact form.