Anxiety symptoms are common in people with HIV infection, and are likely to be more prominent at times of significant life stresses and at stages of disease progression.[23] Anxiety disorders, where anxiety is severe and persistent, are also common: surveys have estimated the prevalence of generalised anxiety disorder to be up to 15% of HIV patients and the prevalence of panic disorder to be 10% of HIV patients.[24] Agoraphobia and social phobia are also common and high rates of post-traumatic stress disorder and acute stress disorder have been described.[25] The presentation of these disorders is often clouded by comorbid mood disorder, substance use and personality disorders making diagnosis more complicated. Effective treatment requires a comprehensive assessment of the presenting symptoms, life stresses and coping style.
Treatment approaches include brief psychological interventions and medication. Psychological approaches that may be helpful include behavioural techniques, such as progressive muscular relaxation, breathing exercises and systematic desensitisation. These may be incorporated within a cognitive behavioural therapy approach [26] and medications are often used concurrently. Benzodiazepines may be helpful for short-term symptom relief, and are usually best used with antidepressant agents and tapered as symptoms improve. Shorter-acting agents that produce fewer metabolites are preferred, such as oxazepam, lorazepam and temazepam, with consideration given to risks, such as abuse and dependence. Antidepressants are effective for the longer-term treatment of anxiety, with SSRIs being the first-line choice, again choosing agents that have less hepatic cytochrome p450 interactions. Mirtazapine and venlafaxine can also be effective.