Mental health syndemics reduce ART adherence and impair viral suppression in people living with HIV.

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Frontiers in Medicine Published April 13, 2026 Medically reviewed April 25, 2026 Study authors: Atitegeb A. Kidie, David Serunjogi, Solomon M. Demeke, Birtukan G. Ayal, Innocent Mwombeki, Bathsheb… DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note that mental health syndemics are associated with reduced ART adherence and viral suppression in PLWH.

This systematic review and meta-analysis evaluated 32 studies with a combined sample size ranging from 51 to 14,261 participants. The population consisted of people living with HIV (PLWH) across various settings. The study investigated the relationship between the number of mental health-related syndemics and key clinical outcomes, including ART adherence, viral suppression, and mental health quality of life.

The primary analysis revealed a significant negative association between the number of syndemics and ART adherence. The pooled odds ratio (OR) for adherence was 0.73 (95% CI = 0.55 – 0.96), indicating reduced adherence with increasing syndemic burden. Conversely, a positive association was observed between syndemic count and viral suppression, with an OR of 1.26 (95% CI = 1.10 – 1.44) for being virally suppressed. Secondary outcomes included depression, anxiety, schizophrenia, bipolar disorder, PTSD, and psychological distress, alongside quality of life metrics.

Safety and tolerability data were not explicitly reported in the pooled results. However, significant limitations were noted, including wide variation in how syndemics were defined and measured across the included studies. Statistical heterogeneity was high for adherence results (I² = 98.58%) and moderate for viral load results (I² = 52.38%). The authors did not claim causation beyond the reported syndemic impact on outcomes.

The practice relevance highlights the necessity for syndemic-informed holistic care models. These models aim to address the intersecting burden of mental health conditions and psychosocial factors among PLWH. Clinicians should recognize that mental health conditions, particularly depression, strongly influence these synergizing syndemics. Care strategies must account for the complex interplay between psychological distress and HIV management to improve adherence and suppression rates.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

People living with HIV (PLWH) may be exposed to harmful political, social, economic and environmental factors that exacerbate their risk of mental health conditions. Such factors can interact synergistically to worsen HIV and mental health-related outcomes, creating a syndemic. This study aims to review existing literature on mental health-related syndemics and their impact on HIV and mental health outcomes. CINAHL, Embase, MEDLINE, PsycInfo, Scopus and ProQuest were searched. We included observational studies that investigated a potential mental health-related syndemic and/or reported the impact of a syndemic on HIV outcomes (antiretroviral therapy [ART] adherence or viral suppression), or mental health outcomes (mental health-related quality of life, depression, anxiety, schizophrenia, bipolar disorder, post-traumatic stress disorder or psychological distress) among PLWH. Screening, data extraction and quality assessment were conducted by two independent reviewers. The Newcastle-Ottawa Scale (NOS) was used to assess the quality and risk of bias. The impact of syndemic count on ART adherence and viral suppression was pooled using random effects using STATA and the remaining findings were synthesised narratively. PRISMA guidelines were followed. 32 studies were included with sample sizes ranging from 51 participants to 14,261. Six studies reported on mental health-related syndemics among PLWH, four of which found depression or distress to be the most influential syndemic factor. Mental health conditions within syndemics often cluster and are significantly associated with socioeconomic factors such as food insecurity, stigma and violence. Fifteen of 16 studies found a significant association between adherence and the number of mental health-related syndemics. Pooled odds ratio of seven studies showed a significant reduction in adherence (OR = 0.73; 95% CI = 0.55 – 0.96); heterogeneity was high (I2 = 98.58%). Eleven of 13 studies found a significant association between the number of mental health-related syndemics and being virally suppressed. Four studies resulted in a significant pooled odds ratio for having detectable viral load (OR = 1.26; 95% CI = 1.10 - 1.44); heterogeneity was moderate (I2 = 52.38%). Despite wide variation in how syndemics were defined and measured across studies, our findings suggest that mental health conditions, particularly depression, strongly influence synergising syndemics among PLWH, and mental health-related syndemics negatively impact ART adherence and viral load. These findings underscore the need for syndemic-informed holistic care models to address the intersecting burden of mental health conditions and psychosocial factors among PLWH.