Adherence to antiretroviral therapy (ART) is a critical prerequisite for effective HIV control, sustained viral suppression, and prevention of disease progression. Despite the availability of modern ART regimens, a substantial proportion of people living with HIV (PLWH) demonstrate suboptimal adherence, which may be largely influenced by co-occurring mental disorders.

Objective. To assess the role of mental disorders as determinants of reduced adherence to antiretroviral therapy in people living with HIV and to substantiate the clinical relevance of a precision psychiatry approach in HIV care.

The study included 132 PLWH who had been receiving ART for at least six months. All participants underwent clinical, psychiatric, and psychological assessment using standardized diagnostic and psychometric tools. ART adherence was evaluated based on medical records and patient self-report. Multivariate statistical methods, including logistic regression and ROC analysis, were applied to identify predictors of non-adherence.

Depressive and organic mental disorders were significantly associated with reduced adherence to ART. Psychiatric variables demonstrated greater prognostic relevance for non-adherence than demographic characteristics. The predictive model showed high discriminatory ability in identifying patients at increased risk of ART non-adherence and demonstrated adequate calibration between predicted and observed outcomes

Mental disorders represent key determinants of reduced adherence to antiretroviral therapy in people living with HIV. Integration of a precision psychiatry approach, including early psychiatric screening and individualized psychosocial and therapeutic interventions, may improve ART adherence, optimize clinical outcomes, and enhance quality of life in this population.