title: Experience of persistent psychological symptoms and perceived stigma among people with HIV on antiretroviral therapy (ART): a systematic review.
abstract: BACKGROUND
  Advances in HIV care have resulted in increasing numbers of HIV patients receiving antiretroviral therapy and achieving viral control. This has led to a focus on the biomedical aspects of care, leaving the data on psychological and social problems relatively neglected; in fact they have never before been systematically reviewed. If present and unmanaged, psychological and social problems are associated with unnecessary suffering and non-adherence to medication, with potentially serious clinical and public health consequences.
  
  
  OBJECTIVE
  To assess the prevalence of depression and anxiety reported in the literature, and the presence or absence of the experience of stigma among HIV positive people on antiretroviral therapy.
  
  
  METHODS
  A systematic review in line with PRISMA guidelines. The prevalence data from retained studies were analysed by study location and data quality.
  
  
  METHODS
  Five databases were systematically searched (Embase, PsychINFO, MEDLINE and British Nursing index and Web of Science) from 1996 (first availability of highly effective antiretroviral therapy) to August 2013 using a predefined search strategy.
  
  
  RESULTS
  Sixty-six original studies identified the prevalence of depression, anxiety and presence or absence of the experience of stigma. The mean point prevalence of depression was 33.60% (SD 19.47) with lower reported point prevalence in high income countries (25.81% (15.21)) compared to low and middle income countries (41.36% (21.42)). The one-to four-week period prevalence of depression was 39.79% (21.52), similar in high income countries and low and middle income countries. The point prevalence of anxiety was 28.38% (17.07), with a higher prevalence in low and middle income countries (33.92% (10.64)) compared with high income countries (21.53% (22.91)) with wide variability. The mean point prevalence of stigma was 53.97% (22.06) and 1 year period prevalence 52.11% (25.57). Heterogeneity in both sampling and methodology prevented meta-analysis of this data.
  
  
  CONCLUSIONS
  HIV positive patients on antiretroviral therapy report a higher prevalence of depression and anxiety than the general population, which nursing assessment and practice should address. Over half of HIV positive people report experiencing stigma. The difficulties with heterogeneous studies should be addressed through the development of a cross-culturally validated, multidimensional assessment tool in this population, and an increase in data disaggregated by risk groups.
authors.affiliation: Cicely Saunders Institute, King's College London, Bessemer Road, London SE5 9PJ, United Kingdom. Electronic address: Keira.lowther@kcl.ac.uk.
authors.forename: Keira
authors.initials: K
authors.lastname: Lowther
authors.affiliation: Cicely Saunders Institute, King's College London, Bessemer Road, London SE5 9PJ, United Kingdom.
authors.forename: Lucy
authors.initials: L
authors.lastname: Selman
authors.affiliation: Cicely Saunders Institute, King's College London, Bessemer Road, London SE5 9PJ, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
authors.affiliation: Cicely Saunders Institute, King's College London, Bessemer Road, London SE5 9PJ, United Kingdom.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D010349:Patient Compliance; D013240:Stereotyping
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; Anxiety; Depression; HIV/AIDS; Stigma