Table 5.

Anxiety and its disorders in relation to HIV/AIDS clinical processes (ordered chronologically by sub-category).

Authors	Study characteristics	Clinical process	Outcome measured	Design	Main finding
Disease severity and progression
Rabkin et al., 1991	n = 124, 87% Caucasian, mean age = 38	Hamilton Rating Scale for Anxiety (HAM-A2)	CD4 T-cell and lymphocyte subsets via blood testing	Cross-sectional; prospective	No significant relation between anxiety and CD4 T-cell decline or lymphocyte subsets cross-sectionally (ESU) or prospectively (r2 = 0.03)
Vassend, Eskld, & Halvorsen, 1997	n = 65 PLWHA living in Oslo, Norway; mean age = 38	Symptom Checklist-90 (SCL-903)	CD4 T-cell counts via blood testing	Prospective	Anxiety was not related to CD4 T-cell count (ESU) but was related to other possibly relevant factors, such as avoidant coping behavior (r2 = 0.12)
Thornton et al., 2000	n = 161 PLWHA in London, 92.4% Caucasian, mean age = 40.4	General Health Questionnaire 28 (GHQ-284)	CD4 T-cell count via blood testing	Prospective	“Anxiety and insomnia” as measured by the GHQ-28 was not significantly related to CD4 T-cell count (HR = 1.04)
Pence, Miller, Gaynes, & Eron (2007)	n = 198 cART naive PLWHA	7 Substance Abuse and Mental Illness Symptom Screener (SAMISS; Pence et al., 2005)	7 Substance Abuse and Mental Illness Symptom Screener (SAMISS; Pence et al., 2005)	Prospective	Participants with a higher predicted probability of mental illness and substance abuse took longer to achieve virologic suppression (adjusted hazard ration [aHR] = 0.86) and were quicker to demonstrate virologic failure (aHR = 1.22)
Fincham, Smit, Carey, Stein, & Seedat, 2008	n = 456 PLWHA in South Africa, 72.4% Black, 67.3% Xhosa-speaking, 25% male	Anxiety disorder diagnosis (MINI1)	CD4 T-cell count via self-report	Cross-sectional	Anxiety disorder diagnosis was not predictive of CD4 T-cell count (Effect Size Unavailable [ESU])
Nurutdinova et al., 2012	n = 9003 Military Veterans, 98% male, 43% African American	ICD-95 anxiety disorder diagnoses via medical records review	CD4 T-cell count via medical record review	Prospective	Anxiety disorders were protective of all-cause mortality (OR = 0.80) and AIDS-defining illness (OR = 0.83)
HIV medication adherence
Catz, Heckman, Kochman, & DiMarco, 2001	n = 113 PLWHA, age 47–69	Anxiety and somatization via the Symptom Checklist 90-Revised (SCL-90-R6)	Self-reported past-week HIV medication adherence	Cross-sectional	Patients reporting adhering to their medication had significantly lower levels of anxiety (r2 = 0.06) and somatization (r2 = 0.10)
Van Servellen, Chang, Garcia, & Lombardi, 2002	n = 182, 56.93% male, 42.7% Hispanic, average age 38.15	Hospital Anxiety and Depression Scale (HADS7)	Self-reported HIV medication adherence, confirmed with medical record review	Cross-sectional	HADS Anxiety scores significantly predicted self-reported HIV medication nonadherence (r2 = 0.05)
Mellins et al., 2002	n = 128, 58% African American, mean age = 38	Clinical Diagnostic Questionnaire (CDQ8)	self-report taken from the Adult AIDS Clinical Trials Group (AACTG9)	Cross-sectional	Presence of any psychiatric disorder (OR = 8.76) predicted missed HIV medication
Escobar, Venturelli, Escobar-Islas, & Hoyo-Vadillo, 2003	n = 283, 68.6% male, mean age = 36	State-Trait Anxiety Inventory (STAI10)	Percentage of prescriptions filled in the past 4–6 months	Cross-sectional	Medication nonadherent patients were more likely to score > 75% on the STAI state or trait anxiety scales (OR = 3.49) compared to medication adherent patients
Palmer et al., 2003	n = 107 opioid-addicted PLWHA, 47% male, 63% Hispanic	Structured Clinical Interview for the DSM-IV Axis I (SCID-I13)	AACTG9 measurement of past 3 day adherence	Cross-sectional	Anxiety disorders were not significantly related to missed HIV medication (ESU)
Tucker et al., 2003	n = 1910, 78% male, 32% African American	Composite International Diagnostic Interview – Short Form (CIDI-SF12)	Self-reported HIV medication adherence	Prospective	GAD (OR = 2.4) and Panic Disorder (OR = 2.0) significantly predicted nonadherence to HIV medication one year later
Carrieri et al., 2003	n = 96 drug-injecting HIV infected persons, 68.8% men	Self-reported symptoms of anxiety	Self-report of adherence in the past week	Prospective	Anxiety-related somatic symptoms significantly predicted HIV medication non-adherence in the past week (OR = 2.7) six months later
Waldrop-Valverde & Valverde, 2005	n = 58 HIV+ injection drug users, 25.9% homeless, 24.1% female	STAI10	Self-reported one-day adherence	Cross-sectional	Anxiety was not significantly related to past-day adherence (ESU)
Schönnesson, Williams, Ross, Bratt, & Keel, 2007	n = 193 PLWHA in Sweden, 100% Caucasian, 75% male, mean age = 43	The Brief Symptom Inventory (BSI11)	Self-report confirmed with medical record review	Cross-sectional	Anxiety symptoms predicted sub-optimal HIV medication adherence (OR = 6.25)
Roux et al., 2009	4963 PLWHA in France	HADS7	Self-reported adherence and virology data	Cross-sectional	Anxiety symptoms were associated with nonadherence to cART in men (OR = 1.5) but not women (ESU).
Campos et al., 2010	n = 293 Brazilian PLWHA, 65.9% male	HADS7	Semi-structured clinical interview measuring past 3 day adherence	Prospective	Severe symptoms of anxiety predicted HIV medication non-adherence (RH [Relative Hazard] = 2.28)
Nel & Kagee, 2013	n = 107 HIV infected persons in South Africa, 82.2% female	Beck Anxiety Inventory (BAI14)	Self-report scale for medication adherence15	Cross-sectional	No significant relation was found between anxiety and medication adherence (OR = 1.425)
Kosiba et al., 2014	n = 131 PLWHA in treatment for opioid use	MINI International Neuropsychiatric Interview (MINI15)	Medication-Event-Monitoring-System (MEMS; AAR-DEX)	Cross-Sectional	Presence of panic disorder significantly predicted medication adherence (r2 = 0.05)
Substance use
Comulada et al., 2010	n = 936 PLWHA provided an HIV transmission prevention trial	STAI10	Self-reported substance use	Cross-sectional and prospective	Lower rates of baseline anxiety were predictive of increasing alcohol and marijuana use over time (r2 = 0.05), as well as hard drug use over time (r2 = 0.11); prospectively, however, elevated anxiety symptoms were related to elevated alcohol and marijuana use (r2 = 0.003) and hard drug use (r2 = 0.01)
Ibanez, Purcell, Stall, Parsons, & Gomez, 2005	n = 1168 HIV+ gay and bisexual men, 236 Injection Drug Users (IDU), 500 non-IDU, and 422 non-users	BSI11	Self-reported use in the past 90-days	Cross-sectional	IDU participants reported significantly higher anxiety compared to non-IDU and non-using groups (F-test = 17.22, estimated effect size = 0.33)
Staton-Tindall et al., 2015	n = 136 HIV+ females incarcerated for drug use	Global Appraisal of Individual Needs (GAIN-I16)	NM-Assist17	Cross-sectional	Participants reporting anxiety reported higher rates of substance use (ESU) and participants reporting concurrent anxiety and substance use had significantly increased numbers of past-year male sexual partners (IRR = 1.03)
Garey et al., 2015	n = 94 PLWHA, 88.3% male, 42.6% Caucasian	Inventory of Depression and Anxiety Symptoms (IDAS18)	Alcohol Use Disorders Identification Test (AUDIT19)	Cross-sectional	Hazardous alcohol use predicted higher rates of panic symptoms (r2 = 0.11) and social anxiety symptoms (r2 = 0.12)
Sexual risk taking behavior
Kennedy et al., 1993	n = 106 serodiscordant heterosexual couples	BSI	Self-reported condom use in the past month	Cross-sectional	Anxiety negatively predicted condom use among women, but not men in serodiscordant couples (ESU)
Kalichman, 1999	n = 203 HIV+ men and 129 HIV+ women, mean age = 37.2, 67% African American	BSI	Self-report of past six-month anal and vaginal sexual intercourse instances, number of partners, condom use, and HIV status of partners	Cross-sectional	No differences were found between sexual low-risk and high-risk individuals in anxiety status (ESU)
O’Leary, Purcell, Remien, & Gomez, 2003	n = 456 HIV+ men who have sex with men, average age = 37, 30% Caucasian	BSI	Self-report of past 90-day unprotected anal sex with	Cross-sectional	Anxiety mediated the relations between childhood sexual abuse and insertive and receptive anal intercourse (ESU)
Bancroft et al., 2003	n = 589 HIV+ MSM, 87.5% white, 92% attended at least some college	STAI10	Kinsey Institute Sexual Activity and Condom Use Questionnaire (KISACUQ; Bancroft et al., 2004); self-report of sexual partners and condom use	Cross-sectional	Higher train anxiety predicted greater likelihood of being in a high-risk sexual group (r2 = 0.10)
Roberts, Wechsberg, Zule, & Burroughs, 2003	n = 355 African-American crack abusing HIV+ women	Drug Abuse Treatment for AIDS Risk Reduction, anxiety subscale (Simpson, 1990)	Risk Behavioral Assessment (RBA; Needle et al., 1995)	Cross-sectional	women with multiple sexual partners in the past month reported higher anxiety symptoms (ESU)
Comulada et al., 2010	n = 936 PLWHA provided an HIV transmission prevention trial	STAI10	Self-report of sex acts	Cross-sectional and Prospective	Cross-sectionally, increased anxiety predicted nonsignificant decreases in risk sexual acts (r2 = −0.44) and number of HIV-negative partners (r2 = −0.01); prospectively, increased anxiety predicted nonsignificant increases in risky sexual acts (r2 = 0.001) and significant increases in HIV-sexual partners (r2 = 0.005)
O’Cleirigh, Traeger, Mayer, Magidson, & Safren, 2013	n = 503 HIV+ men, mean age = 41.9, 75% Caucasian	Mini Social Phobia Inventory (MINI SPIN21) and Patient Health Questionnaire (PHQ22)	Self-reported frequency of unprotected anal sex with HIV-negative or unknown partners in the past three months	Cross-sectional	Symptoms of social anxiety and panic did not significantly predict sexual risk taking behavior (ORs = 1.24, 1.02, respectively)
Cardoso & Malbergier, 2015	n = 667 PLWHA in Brazil, 57.4% male,	BAI14	Self-reported past six-month sexual behavior	Cross-sectional	Individuals reporting severe anxiety reported consistent condom use at half the rate of those indicating no anxiety (OR = 0.523)
Mimiaga et al., 2015	n = 1210 sexually active men living with HIV/AIDS	PHQ22	Self-reported past-month consistent condom use	Cross-sectional	Individuals reporting high anxiety were more likely to have had unprotected anal intercourse (OR = 1.7) and multiple unprotected anal intercourse partners (OR = 1.54) in the past six months.
Quality of life
Hasanah et al., 2011	n = 271, 57.6% male, 86.3% Malaysian ethnicity	HADS7	Functional Assessment of Chronic Illness Therapy (FACIT27)	Cross-sectional	Anxiety significantly predicted poorer quality of life (adjusted regression coefficient = −36.41)
Psaros, O’Cleirigh, Bullis, Markowitz, & Safren, 2013	n = 108 HIV+ intravenous drug users, 55.6% male, 48.1% Caucasian	BAI14	AIDS Clinical Trials Group Short Form-21 (ACTG-SF-2128) including measurement of general health, physical functioning, role functioning, and pain	Cross-sectional	Anxiety was significantly related to general health (r2 = 0.13), physical functioning (r2 = 0.08), rule functioning (r2 = 0.14), and pain (r2 = 18)
Stanley, Sethuramalingam, & Sathia, 2014	n = 309, 32.4% male	Depression Anxiety and Stress Scale (DASS23)	World Health Organization Quality of Life Questionnaire Brief version (WHOQOL-BREF24)	Cross-sectional	Results indicated that higher anxiety was significantly related to lower quality of life (r2 = 0.28)
Surah et al., 2013	n = 55, 64% male, mean age = 37	HADS7	SF-3625 and EQ-5d26	Cross-sectional	Higher rates of anxiety were significantly related to lower quality of life, regardless of health status (r2 = 0.21)
Zimpel & Fleck, 2014	n = 308 PLWHA in Brazil, 60.4% male, 27.9% AIDS diagnosed	STAI10	World Health Organization Quality of Life Questionnaire HIV version (WHOQOL-HIV24)	Cross-sectional	Trait anxiety significantly predicted total HIV-related quality of life (r2 = 0.03)
Suicidality
Quintana-Ortiz, Gomez, Baez Feliciano, & Hunger-Mellado, 2008	n = 714 PLWHA in Puerto Rico, 67.4% men	Self-report	Self-report	Prospective	Participants reporting episodes of anxiety “sometimes” and “frequently” reported significantly higher odds of suicide attempts one year later (OR = 7.41, 1.96, respectively)
Peng et al., 2010	n = 535, mean age = 34.6	Brief Symptom Rating Scale-5 (BSRS-529)	Two questions on lifetime suicidal thoughts/attempts	Cross-sectional	Past-week symptoms of anxiety or tension significantly predicted lifetime suicidal ideation (OR = 2.56)
Kinyanda, Hoskins, Nakku, Nawaz, & Patel, 2012	n = 618 PLWHA living in Uganda, 27.3% male	MINI International Neuropsychiatric Interview MINI30	(MINI30)	Cross-sectional	Results indicated that 0.81% (n = 5) of the sample met criteria for GAD, and 60% of those participants met criteria for current suicidality (OR = 18.9)
Passos, Souza, & Spessato, 2014	n = 211, 47.9% male	HADS7	MINI30	Cross-sectional	Participants reporting anxiety had a significantly higher suicide risk compared to non-anxious individuals (relative risk = 2.43)
Cognitive impairment
Woods et al., 2007	n = 75 HIV+ persons, 94.7% male, 66.7% Caucasian, compared to 60 HIV− controls, 56.7% male, 56.7% Caucasian	Profile of Mood States (POMS33)	Prospective and Retrospective Memory Questionnaire (PRMQ34)	Cross-Sectional	“Tension/anxiety” and “fatigue” significantly predicted prospective memory complains among the HIV+ group (r2 values = 0.06, 0.10, respectively)
Au et al., 2008	n = 90 PLWHA in Hong Kong, 82.2% male, mean age = 39.24	STAI10	Hong Kong List Learning Test (HKLLT31); Patients Assessment of Own Functioning Inventory (PAOF-Memory32)	Cross-Sectional	Self-reported trait anxiety did not predict total learning, 10-minute delayed recall, 30-minute delayed recall, or discrimination between stimuli (r2 values = 0.00 to 0.02, ns) but did predict patient’s assessment of own functioning (r2 = 0.11)
Malaspina et al., 2011	n = 74 PLWHA	POMS33; CIDI12	A combination of professionally-administered neurocognitive tests and self-report of cognitive complains used to measure successful cognitive ageing (SCA35)	Cross-sectional	Present of a DSM-IV defined anxiety disorder did not predict SCA (ESU), however, those endorsing SCA endorsed lower rates of tension-anxiety, and fatigue (ESU)
Micali, Zirilli, & Abbate, 2011	n = 30 HIV+ men living in Sicily, mean age = 35.59	POMS33	Wechsler Adult Intelligence Scale (WAIS-R36)	Prospective	At 18-months post-baseline appointment, tension/anxiety significantly predicted cognitive decline (ESU)

¹MINI International Neuropsychiatric Interview (MINI; Sheehan et al., 1998);

²Hamilton Rating Scale for Anxiety (HAM-A; Hamilton, 1959);

³Symptom Checklist 90 (SCL-90; Derogatis and Melisaratos, 1983);

⁴General Health Questionnaire 28 (GHQ-18; Mulder, Antoni, Duivenvoorden, Kaufmann, & Goodkin, 1995);

⁵International Classification of Diseases-9; (ICD-9, US Department of Health and Human Services, 1980);

⁶Symptom Checklist 90-Revised (SCL-90-R; Derogatis and Melisaratos, 1983);

⁷Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983);

⁸Clinical Diagnostic Questionnaire (CDQ; Aidala et al., 2004);

⁹Adult AIDS Clinical Trials Group (AACTG; Chesney et al., 2000);

¹⁰State-Trait Anxiety Inventory (STAI, Spielberger, Gorsuch, & Lushene, 1970);

¹¹The Brief Symptom Inventory (BSI; Derogatis & Melisaratos, 1983);

¹²Composite International Diagnostic Interview – Short Form (CIDI-SF; Kessler et al., 1998b);

¹³Structured Clinical Interview for the DSM-IV Axis I (SCID-I; First, Gibbon, Spitzer, & Williams, 1995);

¹⁴Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988);

¹⁵Self-report scale for medication adherence (Simoni et al., 2006);

¹⁶Global Appraisal of Individual Needs (GAIN-I Version 5; Dennis, 1998);

¹⁷NM-Assist (NIDA, 2009);

¹⁸Inventory of Depression and Anxiety Symptoms (IDAS; Watson et al., 2007);

¹⁹Alcohol Use Disorders Identification Test (AUDIT; Saunders, Aasland, Babor, de la Fuente & Grant, 1993);

²⁰Time Line Follow Back (TLFB; Sobell & Sobell, 1992);

²¹Mini Social Phobia Inventory (MINI SPIN; Connor, Kobak, Churchill, Katzelnick, & Davidson, 2001);

²²Patient Health Questionnaire (PHQ, Spitzer, Kroenke, & Williams, 1999);

²³Depression Anxiety and Stress Scale (DASS; Lovibond & Lovibond, 1995);

²⁴World Health Organization Quality of Life Questionnaire Brief version (WHOQOL-BREF; Skevington, Sartoris, & Amir, 2004);

²⁵SF-36 (Brazier, Roberts, & Deverill, 2002);

²⁶EQ-5D (Gusi, Olivares, & Rajendram, 2010);

²⁷Functional Assessment of Chronic Illness Therapy (FACIT; Peterman, Cella, Mo, & McCain, 1997);

²⁸ACTG-SF-21 (Wu, Hays, Kelly, Malitz, & Bozzette, 1997);

²⁹Brief Symptom Rating Scale (BSRS-5; Lung & Lee, 2008);

³⁰MINI International Neuropsychiatric Interview (MINI; Sheehan et al., 1998);

³¹Hong Kong List Learning Test (HKLLT; Chan & Kwok, 1999);

³²Patients Assessment of Own Functioning Inventory (PAOF-Memory; Chelune, Heaton, & Lehman, 1986);

³³Profile of Mood States (POMS; McNair, Lorr, & Droppleman, 1981);

³⁴Prospective and Retrospective Memory Questionnaire (PRMQ; Crawford et al., 2003);

³⁵Successful Cognitive Ageing (SCA; Antinori et al., 2007);

³⁶Wechsler Adult Intelligence Scale (WAIS-R; Wechsler, 1981).