Neuropsychiatric sequelae of medication non-adherence in people living with HIV

Non-adherence to anti-retroviral therapy (cART) among people living with HIV/AIDS (PLWHA) is complex, multifactorial, and leads to increases in viral load, immunosuppression, and HIV burden related to direct CNS virulence and cART re-initiation (i.e., immune reconstitution syndrome). Among behavioral disturbances, which may become long-lasting without proper treatment, major depressive disorder, generalized anxiety disorder, schizophrenia, and bipolar spectrum disorders are frequent, as well as exacerbation of other premorbid underlying psychiatric conditions, such as post-traumatic stress disorder (PTSD) and substance use and related conditions, not to mention neurocognitive disorders that are encompassed under the umbrella term of HIV-Associated Neurocognitive Disorders (HAND). In this review, we summarized the neuropsychiatric sequelae of medication non-adherence in PLWHA by utilizing two clinical vignettes to illustrate how syndemic factors may interact and lead to unique presentations.